The Fiscal Soundness Reporting Requirements (CMS-906)

Fiscal Soundness Module
Plan User Guide

Prepared by:
HPMS Core Team
CMS/OA/CM/MDBG/DPD
March 2021

Table of Contents
Table of Contents ....................................................................................................................................................... i
Table of Figures ........................................................................................................................................................ ii
1

2

Overview ..................................................................................................................................................... 1
1.1

Accessing HPMS ........................................................................................................................ 1

1.2

Accessing the Fiscal Soundness Module..................................................................................... 1

1.3

Who’s Required to Submit? ........................................................................................................ 2

1.4

Submission Types ....................................................................................................................... 3

1.5

Extensions ................................................................................................................................... 3

1.6

Contract Grouping ....................................................................................................................... 4

1.7

Understanding the Review Status................................................................................................ 5

1.8

Email Notifications ..................................................................................................................... 5

Submission of Financial Information ........................................................................................................... 6
2.1

Submit New................................................................................................................................. 6

2.2

Update ....................................................................................................................................... 12

2.3

Resubmit ................................................................................................................................... 16

3

View Financial Data .................................................................................................................................. 21

4

Submission of Extension Requests ............................................................................................................ 24

5

4.1

New Extension Requests ........................................................................................................... 24

4.2

Update / Withdraw Extension Requests .................................................................................... 28

Reports ....................................................................................................................................................... 30
5.1

Review Status Report ................................................................................................................ 30

6

Documents and Forms ............................................................................................................................... 32

7

Contacts ..................................................................................................................................................... 33

8

PRA Disclosure Statement ........................................................................................................................ 34

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Table of Figures

Figure 1: Fiscal Soundness Start Page............................................................................................................... 2
Figure 2: Submission of Financial Information Page ....................................................................................... 6
Figure 3: Select Reporting Period Page (Non-PACE) ...................................................................................... 7
Figure 4: Select Reporting Period Page (PACE) .............................................................................................. 7
Figure 5: New Financial Submission Page (Non-PACE) ................................................................................. 9
Figure 6: New Financial Submission Page (PACE) ...................................................................................... 10
Figure 7: Verify Financial Information Page (Non-PACE) ............................................................................ 11
Figure 8: Verify Financial Information Page (PACE) .................................................................................... 11
Figure 9: New Submission Attestation Popup (Audited Annual) ................................................................... 12
Figure 10: Confirmation Page......................................................................................................................... 12
Figure 11: Submission of Financial Information Page – Update .................................................................... 13
Figure 12: Select Reporting Period – Update (Non-PACE) ........................................................................... 13
Figure 13: Select Reporting Period – Update (PACE) ................................................................................... 14
Figure 14: Update Financial Submission Page (Non-PACE) .......................................................................... 15
Figure 15: Update Financial Submission Page (PACE) .................................................................................. 16
Figure 16: Submission of Financial Information Page – Resubmit ................................................................. 17
Figure 17: Select Reporting Period – Resubmit (Non-PACE) ........................................................................ 17
Figure 18: Select Reporting Period – Resubmit (PACE)................................................................................. 18
Figure 19: Resubmit Financial Submission Page (Non-PACE) ...................................................................... 19
Figure 20: Resubmit Financial Submission Page (PACE) .............................................................................. 20
Figure 21: Resubmit pop-up ............................................................................................................................ 21
Figure 22: View Financial Data Search Page .................................................................................................. 21
Figure 23: Search Results Page ....................................................................................................................... 22
Figure 24: Financial Data Page ....................................................................................................................... 23
Figure 25: Extension Requests Page ............................................................................................................... 24
Figure 26: Submit Extension Request Page .................................................................................................... 26
Figure 27: Submit Extension Request Verification Page ................................................................................ 27
Figure 28: Extension Request Confirmation Page........................................................................................... 27
Figure 29: Select Extension Request Page ...................................................................................................... 28
Figure 30: Update/Withdraw Extension Request Page.................................................................................... 29
Figure 31: Reports Page .................................................................................................................................. 30
Figure 32: Review Status Report Search Criteria Page .................................................................................. 31
Figure 33: Review Status Report Page ........................................................................................................... 31

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1

Overview

The Health Plan Management System (HPMS) Fiscal Soundness module supports the Centers for
Medicare and Medicaid Services’ (CMS) ability to collect, store, and review audited annual financial
information submitted by Medicare Advantage Organizations (MAOs), Prescription Drug Plans, 1876
Cost Plans, Medicare-Medicaid Plans (MMPs), and Programs of All Inclusive Care for the Elderly
(PACE). The Fiscal Soundness module supports tracking and monitoring of CMS fiscal soundness
review activities. In addition, the module serves as a data repository for all historical and current MA,
1876 Cost Plans, PACE and Part D financial information and review history.
Note: Contract Year “20XX” in screen prints represents the latest Contract Year. Screen prints and
test contract numbers contained in this User Guide are not intended to display complete
functionality or actual contracts, and are for demonstration purposes only.

1.1 Accessing HPMS
To access the HPMS, Plan users must have a CMS EUA User ID, and must have Internet access. If you
have any questions about your connectivity or do not have access to the appropriate contracts, please send
your questions to [email protected].
If you have any questions about the Fiscal Soundness Reporting Requirements contained within, please
send your questions to [email protected] or your Financial Management Specialist.

1.2 Accessing the Fiscal Soundness Module
1. Logon to HPMS and select “Fiscal Soundness” from the “Monitoring” section of the main menu
toolbar.
2. The Fiscal Soundness Start page (Figure 1) displays. From this page, you have the option to select
navigation links from the Fiscal Soundness navigation Menu.
Note: The following pages have the ability to be saved as a Favorite within the HPMS site.

•

Submission of Financial Information

•

Submission of Extension Requests

•

Reports

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Figure 1: Fiscal Soundness Start Page

1.3 Who’s Required to Submit?
The contract types listed below are required to submit their financial information. These include active
contracts that have not been terminated and have a NAIC number assigned to the profile (contracts must
indicate if no NAIC number is assigned) that belong to the following plan types:
•
•
•
•
•
•
•
•
•
•
•

HMO
HMOPOS
Local PPO
Fallback
PSO (State License)
MSA
RFB PFFS
PFFS
1876 Cost
National PACE
Medicare Prescription Drug Plan

•

Employer/Union Only Direct Contract PDP

•

Regional PPO

•
•
•
•
•

Employer/Union Only Direct Contract PFFS
Employer/Union Only Direct Contract LPPO
RFB HMO
RFB HMOPOS
RFB Local

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•
•
•
•

RFB PSO (State License)
Financial Alignment HMO
Financial Alignment HMOPOS
Financial Alignment PPO

1.4 Submission Types
CMS requires organizations to submit financial information at certain intervals (e.g. Submission Types)
throughout each year:
•

Audited Annual – The audited annual (AA) financial statement covers the closure of the previous
fiscal year
Reporting Period Ending 3/31 – For quarters ending between 1/1 - 3/31
Reporting Period Ending 6/30 – For quarters ending between 4/1 - 6/30
Reporting Period Ending 9/30 – For quarters ending between 7/1 - 9/30
Reporting Period Ending 12/31 – For quarters ending between 10/1 - 12/31. PACE contracts
only.

•
•
•
•

Note: Each Submission Type has a Period End Date (PED) and a Period Due Date (PDD). For more
information on Submission Types, PEDs, and PDDs please see Section 6. Organizations may refer to the
CY 2021 Fiscal Soundness Reporting Requirements (FSRR) located in the Documents and Forms section
of the Fiscal Soundness Module for fiscal soundness submission deadlines.

1.5 Extensions
When Non-PACE organizations need more time to submit their audited annual or quarterly financial
statements, Plan users may submit extension requests. Once extension requests are submitted, CMS will
review the request and approve/deny it. Please refer to Section 4 for details.
Note:
•

Extension Requests can be submitted for one or multiple groups of contracts.

•

Upon approval, the extension date overrides the original PDD for the Contract Year/Submission
Period/Contract(s).

•

Regular and Perennial Extensions exist. Perennial extensions are permanent extension requests
that carry forward to future Contract Years.

•

If a new contract is linked to the same NAIC number of an existing contract that already has
an approved perennial extension, the organizations need not submit a new extension request.
The system will automatically apply the approved perennial extension to the new contract.

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The Extension Status indicates the current disposition of the financial submission. A complete status
listing is provided below:
•

Not Started – This status is assigned by the system when an organization submits an extension
request for review. This status is assigned by the system only.

•

In Review – CMS began review of the request, but did not assign a final status.

•

Approved – Approved based on CMS guidelines.

•

Denied – Denied by CMS.

•

Withdrawn – Plan or CMS user no longer requires the extension request.

1.6 Contract Grouping
Most licensed insurance companies have been issued a National Association of Insurance Commissioners
(NAIC) number. CMS requires that ALL organizations enter the NAIC number in HPMS for each
contract number as well as each Parent Organization. For those organizations that do not have a NAIC
number for the contract and/or Parent Organization, you must indicate such in the Contract Management
module. Organizations that have not completed the NAIC data entry in a timely fashion will not be able
to complete their fiscal soundness submissions.
Organizations can access the NAIC data entry fields by navigating the following path in HPMS:
HPMS Start Page > Contract Management > Basic Contract Management > Select Contract Number >
NAIC Data.
Note:
•

Groups are determined based on NAIC numbers.
o

If a contract does not have a NAIC number and needs to be grouped with another
contract, an alternate NAIC is assigned to the contract.

•

When contracts are not under the same Parent Organization but have a relationship, they are
assigned a Joint Venture NAIC number. For Joint Venture entities, the system validates the
grouping based on the Joint Venture NAIC number.

•

Groups can change over time. When this happens, and the change occurred after a submission
(financial or extension request), the page will alert you that the group has changed.

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1.7 Understanding the Review Status
The Review Status indicates the current disposition of the financial submission. A complete status listing
is provided below:
•

Not Reviewed – This status is assigned by the system when an organization submits a fiscal
soundness submission for review. This status is assigned by the system only.

•

Pending – Reviewed, but missing information (e.g. Audited Annual Financial Statement) or
unable to review due to receiving out of sequence (e.g. Quarterly submission prior to AA review).

•

Resubmit – Resubmission has been requested due to incomplete/incorrect data.

•

Meets – Meets CMS’s fiscal soundness requirements.

•

Meets Based on Parent – Meets CMS’s fiscal soundness requirements based on the Parent
Organization’s financials statements.

•

Does Not Meet – Does not meet CMS’s fiscal soundness requirements.

•

Reviewed – Reviewed, but no financial statements are available for the legal entity (e.g. new
organization without operations for the Reporting Period End Date).

•

Did Not Resubmit – Plan did not resubmit as requested within the 10 day window. This status is
assigned by the system only.

1.8 Email Notifications
The following notification events occur within this module:
•

Required to Submit Quarterly Financial Statements

•

Resubmit

•

Extension Approval

•

Extension Denial

•

Extension Request Submitted

In addition, the following notification events are triggered on a nightly basis:
•

14 days in advance of any due date

•

3 days after due date

•

14 days after due date

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•

21 days after due date

•

100 days after due date

2

Submission of Financial Information

The purpose of the Submission of Financial Information function is to submit financials for review.
Users have three submission choices:
•

Submit New – First time submitting for a given contract year/submission type/contract.

•

Update – Updating an existing submission after submission but before the deadline (PDD).

•

Resubmit – Updating an existing submission after CMS has requested resubmission.

2.1 Submit New
How to Submit New Financial Information:
1. Select Submission of Financial Information from the navigation menu.
2. On the Submission of Financial Information page (Figure 2), select desired Contract
Number/Name or one from the contract group.
Figure 2: Submission of Financial Information Page

3. Then select Next.
4. On the Select Reporting Period page (Figure 3) or (Figure 4), select Submit New
under the desired reporting period.
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Figure 3: Select Reporting Period Page (Non-PACE)

Figure 4: Select Reporting Period Page (PACE)

5. Fill out the New Submission from displayed in Figure 5 or Figure 6.
Note: If there are multiple contracts under the selected contract’s NAIC number, the system
will auto-populate the contracts from the NAIC group.
a. Total Assets – This total amount is found on the Balance Sheet.
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b. Total Liabilities – This total amount is found on the Balance Sheet. For PACE or 1876 Cost
Plan contracts, this amount includes Subordinated/Guaranteed Debt.
c. Subordinated Debt/Guaranteed Debt (Included in Total Liabilities) – PACE or 1876
Cost Plan contracts only. Subordinated debt is defined as an unsecured debt whose
repayment to its Parent Organization ranks after all other debts have been paid when the
subsidiary files for bankruptcy. An example of subordinated debt is when the Parent
Organization loans money to the PACE organization or Cost Plan to pay its debts. The
PACE organization or Cost Plan only needs to repay the Parent Organization after all of its
other liabilities have been satisfied. Guaranteed debt is defined as secured debt in which
another entity promises to pay a loan or other debt if the organization that borrowed the
money fails to pay. An example of guaranteed debt is when the PACE organization or Cost
Plan obtains a loan from a bank and another entity signs on to guarantee payment of all, or a
portion of, the loan. In the event of bankruptcy or default, the other entity will make
payments on the loan on behalf of the PACE organization or Cost Plan to ensure the debt is
satisfied.

Note:
•

When a value of zero is entered, the system will alert the user.

•

When entering a numeric value other than zero, users are expected to include a
signed Subordinated/Guaranteed Debt Attestation Form zipped with their file upload.
The form can be accessed by selecting Subordinated/Guaranteed Debt Attestation
Form at the bottom of the page or in the navigation menu.

d. Net Income (Loss) – This is the portion of revenue remaining after all the expenses and taxes
have been deducted. This amount is found as a line item on the Revenue and Expense
Statement. This amount can also be a negative number. In that case, it's called a Net Loss.
e. Cash Flow from Operations – This amount is found on the Cash Flow Statement. It is
the first sub-totaled amount before accounting for cash flow from investing and financing
activities.
f.

File – Upload the applicable financial statement(s).
Note:
•

Accepted file types are .DOC, .DOCX, .PDF and .ZIP. Filename cannot contain
any of the following characters: pound (#), percent (%), semi-colon (;), plus (+),
ampersand (&), and double periods (..).

•

Maximum file size allowed is 20MB.

•

Uploaded file name length should not exceed 150 characters.

g. Subordinated/Guaranteed Debt Attestation – PACE contracts only. When entering a
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numeric value other than zero, users are required to indicate that the
Subordinated/Guaranteed Debt Attestation form has been included in their submission by
selecting the Subordinated/Guaranteed Debt Attestation checkbox.
Note:
•

1876 Cost Plans should contact CMS regarding Subordinated/Guaranteed Debt
Attestation.
Figure 5: New Financial Submission Page (Non-PACE)

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Figure 6: New Financial Submission Page (PACE)

6. After completing all information, select Next.
7. Review the information provided on the New Financial Submission Verification page (Figure 7) or
(Figure 8).
h. If further changes need to be made, select Back.
i.

If the information is correct, select Submit

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Figure 7: Verify Financial Information Page (Non-PACE)

Figure 8: Verify Financial Information Page (PACE)

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8. An attestation of the submission is required (Figure 9). Select the OK.
Figure 9: New Submission Attestation Popup (Audited Annual)

9. Upon submission, the Confirmation page is displayed (Figure 10).
Figure 10: Confirmation Page

10. Select Exit to Home Page to return to the Fiscal Soundness Start Page.

2.2 Update
To update financial information:
1. Select Submission of Financial Information from the navigation menu.
2. On the Submission of Financial Information page, select desired Contract Number/Name or
one from the contract group.

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Figure 11: Submission of Financial Information Page – Update

3. Then select Next
4. On the Select Reporting Period page (Figure 12) or (Figure 13), select Update under
the desired reporting period and select Continue.
Note: The submission will not be available to update if it has been reviewed by CMS, regardless of PDD.
Figure 12: Select Reporting Period – Update (Non-PACE)

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Figure 13: Select Reporting Period – Update (PACE)

5. On the Update Financial Submission page, you may Update values and/or upload
file from previous submissions.
Note: If a previously uploaded file needs to be replaced/deleted, please upload a new zip
file, including all the necessary documents. The newly uploaded file will replace the
previous file.

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Figure 14: Update Financial Submission Page (Non-PACE)

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Figure 15: Update Financial Submission Page (PACE)

6. Select Next and continue through the verification, attestation, and confirmation (See Section 2.1
starting with step 7).

2.3 Resubmit
To Resubmit Financial Information:
1. Select Submission of Financial Information from the navigation menu.
2. On the Submission of Financial Information page, select desired Contract Number/Name or
one from contract group.
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Figure 16: Submission of Financial Information Page – Resubmit

3. Then select Next.
4. On the Select Reporting Period page, select Resubmit under the desired reporting
period and select Continue.
Figure 17: Select Reporting Period – Resubmit (Non-PACE)

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Figure 18: Select Reporting Period – Resubmit (PACE)

5. On the Resubmit Financial Submission page, you may resubmit values and/or upload
file from previous submissions.

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Figure 19: Resubmit Financial Submission Page (Non-PACE)

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Figure 20: Resubmit Financial Submission Page (PACE)

6. Select Next and continue through the verification, attestation, and confirmation (See
Section 2.1 starting with step 7).
Note: If a previously uploaded file needs to be replaced/deleted, please upload a new zip
file, including all the necessary documents. The newly uploaded file will replace the
previous file.

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Figure 21: Resubmit pop-up

3

View Financial Data

The purpose of the View Financial Data function is to view the financials for existing submissions.
To view a submission:
1. Select View Financial Data from the navigation menu.
2. On the View Financial Data Search page (Figure 22), populate search criteria (Optional).

Figure 22: View Financial Data Search Page

3. Select Submit.
4. On the Search Results (Figure 23) page select the appropriate Submission ID.
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Figure 23: Search Results Page

5. The Financial Data Page (Figure 24) displays submission information for the selected Submission
ID.
Note: The following fields were available for submissions prior to 2010. These fields will display
if financial data had been entered at that time:
a. Cash and ST Investments
b. LT Liquid Investments (Non-PDP only)
c. Total Claims (Non-PDP only)
d. Total Revenue
e. Total Expenses
f.

Total Medical and Hospital (Non-PDP only)

g. Total Administrative Expenses
h. Total Member Months (Non-PDP only)
i.

Total Current Assets (PDP only)

j.

Total Current Liabilities (PDP only)

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k. Drug Benefit Expenses (PDP only)
l.

Drug Benefit Revenues (PDP only)

Figure 24: Financial Data Page

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4

Submission of Extension Requests

The purpose of the Submission of Extension Requests function is to submit extension requests for
review. Users have two extension request choices:
•

Request New Extension– First time submitting an extension request for a given
contract year/submission type/contract.

•

Update / Withdraw Extension – Updating an existing extension request prior to CMS Review.

Note: Once approved, Extension dates are visible in the following locations: Review Status Report
(Section 5.1).

4.1 New Extension Requests
To submit a new extension request:
1. Select Submission of Extension Requests from the navigation menu.
2. On the Extension Requests page (Figure 25), select Request New Extension and select
Continue.
Figure 25: Extension Requests Page

3. On the Submit Extension Requests (Figure 26) page fill out the new extension form.
a. PACE Contracts – Select Yes or No.
Note:
• All newly effective contracts will not be displayed on the page until the Fiscal
Soundness Module release in late March.
• If a new contract is linked to the same NAIC number of an existing contract that has
approved perennial extension, the organizations need not submit a new extension
request. The system will automatically apply the approved perennial extension to the
new contract.
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b. Submission Type – The submission type for which the extension is being made.
For more information, see Section 1.5.
c. Contract Name / Number – Contracts that are assigned to the user currently logged in.
Note: If applicable, contracts must be submitted in NAIC groups. For more
information, see Section 1.6.
d. Requested Extension Date – Extension Date requested.
Note: Must be greater than or equal to the current date.
e. Select the Extension as Perennial – Select this box if this is a perennial extension request.
A perennial request is considered a permanent one. Please refer to the instructions in
Section 1.5.
f.

Reason for Extension – Provide reason for extension request.

g. File – Upload the applicable financial statement(s) and supporting documentation (e.g.
NAIC or State Filing Checklist Form).
Note:
• Accepted file types are .DOC, .DOCX, .PDF and .ZIP.
• Filename cannot contain any of the following characters: pound (#), percent (%),
semi-colon (;), plus (+), ampersand (&), and double periods (..).
• Maximum file size allowed is 10MB.
• Uploaded file name length should not exceed 150 characters.
h. Comments – When the Reason for Extension is Other, comments are required.

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Figure 26: Submit Extension Request Page

4. Select Next.
5. Review the information provided on the Submit Extension Request Verification page (Figure 26)
i.

If further changes need to be made, select Back.

j.

If the information is correct, select Submit.

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Figure 27: Submit Extension Request Verification Page

6. Upon submission, the Confirmation page is displayed (Figure 28).
Note: Once an extension request is submitted for a contract/submission type, you may not submit additional
extension requests for the same contract/submission type until the prior extension request have been
approved, denied, or withdrawn.
Figure 28: Extension Request Confirmation Page

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4.2 Update / Withdraw Extension Requests
To update / withdraw an extension request:
1. Select Submission of Extension Requests from the navigation menu.
2. On the Extension Requests page (Figure 25), select Update / Withdraw Extension and select
Continue.
3. On the Select Extension Request Search Results page (Figure 29), locate the appropriate extension
and select the Extension Submission ID.
Note: The submission will not be available to update if it has been reviewed by CMS.
Figure 29: Select Extension Request Page

4. On the Update/Withdraw Extension page (Figure 30) you may update values and/or upload file
from the previous extension request or withdraw the request by selecting Withdraw Request.
Note: If a previously uploaded file needs to be replaced/deleted, please upload a new zip file,
including all of the necessary documents. The newly uploaded file will replace the previous file.

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Figure 30: Update/Withdraw Extension Request Page

5. After completing all information, select Next.
Note: When withdrawing a request, the system prompts you with an additional pop-up message
during submission, asking you to confirming the withdrawal. Once a request is withdrawn, it is no
longer editable by you or by CMS.
6. Review the information provided on Submit Extension Request Verification page (Figure 27).
a. If further changes need to be made, select Back.
b. If the information is correct, select Submit.
7. Upon submission, the Confirmation page is displayed (Figure 28).
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5

Reports

Reports are accessible from the Reports page (Figure 31). To view the Reports page, select Reports
from the navigation menu.
Note: For all reports, any column that is blank means no data has been submitted for the given contract
(and if applicable, to the Joint Venture entities). All reports are exportable to MS Excel.
Figure 31: Reports Page

5.1 Review Status Report
The Review Status Report displays all expected submissions for contracts and the status of the
submissions.
To obtain the Review Status Report:
1. Select Review Status Report.
2. On the Review Status Report page, populate search critieria (Optional) (Figure 32).
3. Select Submit.

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Figure 32: Review Status Report Search Criteria Page

Figure 33: Review Status Report Page

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6

Documents and Forms

The Documents and Forms section, accessible from the Fiscal Soundness navigation menu, contains the
following items:
•

FSRR Final Memo for 2021 FSM Release – This includes any information that CMS would
like to share with Plan Organizations regarding the new submission year.

•

CY 2021 Fiscal Soundness Reporting Requirements (FSRR) – This document provides filing
instructions/guidance to upload financial statements for the Plan Organizations.

•

Fiscal Soundness Requirements and Monitoring – This document summarizes the potential
actions that CMS may take to address organizations not meeting fiscal soundness requirements.

•

Clarification of Fiscal Soundness Requirements – This document provides clarification on the
fiscal soundness requirements.

•

Annual Verification of Parent Organization and Legal Entity Name – This document
includes instructions for reviewing parent organization and legal entity name and reporting
corrections, if applicable.

•

Plan User Guide – The Fiscal Soundness Module User Guide is an all-inclusive document
incorporating the various steps for submitting new financial statements and data elements.

•

Subordinated/Guaranteed Debt Attestation Form – If a PACE organization or 1876 Cost Plan
has a subordinated/guaranteed debt arrangement, CMS requires the Subordinated/Guaranteed Debt
Attestation Form to be submitted.

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7

Contacts
Table 1: Fiscal Soundness Contacts – By Type or CMS Region (“Region Responsible” under “Plan
Management Data”)

Contacts

Joe Millstone
[email protected]
410-786-2976
Andrew Chu
[email protected]
410-786-0488

By Type or CMS Region (“Region Responsible”
under “Plan Management Data”)
All Prescription Drug Plans (PDPs) and MA Organizations
covered under a Financial Report that includes a PDP
Technical HPMS Contact

Table 2: Fiscal Soundness Contacts – Medicare Advantage Organizations Not Covered in Table above (by
“Region Responsible” under “Plan Management Data”)

Contacts

Medicare Advantage Organizations Not Covered in Table
Above (by “Region Responsible” under “Plan
Management Data”)

Emily Davis
[email protected]
410-786-1454

PACE Plans – Atlanta, Boston, New York
Region 02 – New York

Mark Keller
[email protected]
410-786-0107

Region 01 – Boston
Region 06 – Dallas
Region 09 – San Francisco
Region 10 – Seattle

Joe Millstone
[email protected]
410-786-2976

Region 03 – Philadelphia
Region 04 – Atlanta

David Stysley
[email protected]
410-786-8948
Venita Scott
[email protected] 410786-3139
Christa Zalewski
[email protected]
410-786-1971

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PACE Plans – Dallas, Denver, Kansas City, San Francisco, Seattle
Region 05 – Chicago
Region 08 – Denver
PACE Plans – Chicago, Philadelphia
Region 07 – Kansas City

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8

PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0938-0469 (Expires: August 31, 2022). The time required to complete this
information collection is estimated to average 20 minutes per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the
information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports
Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

HPMS Fiscal Soundness Plan User Guide

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