Crosswalk - 30day

30-day Federal Register Crosswalk: High Level Summary of Revisions

We made minor updates to the coverage decision letter based on comments received during the
60-day review period. The coverage decision letter is issued to applicable integrated plan
enrollees when a request for a service or item is denied. The changes will not result in additional
burden.

Section

Change/Reason

Throughout
We updated fields throughout the letter that read “” to “” for consistency with language
used in the Medicare Advantage and Medicare-Medicaid plan integrated denial notices.
Header

We realigned the contact information field under the title from centered justified to left
justified for readability.

Fourth
Paragraph

We added a sentence to inform the reader there is more information further down in the
letter on how to request a continuation of services during appeal. We included the
following sentence: “See the ‘How to keep getting your during your appeal’ section later in this letter
for information about continuing to receive your during your appeal.”

Section
titled: You
have the
right to
appeal our
decision
Section
titled: There
are two kinds
of appeals

We added the language “to our plan” to clarify that the appeal is filed with the plan. The
sentence now reads: You must appeal to our plan by [Insert specific appeal filing
deadline date in month, date, year format – 60 calendar days from date of letter. Insert
deadline date in bold text].

Section
titled: There
are two kinds
of appeals
Section
titled: How
to keep
getting your
medical

We added instructional language to allow plans to remove the extensions language if a
state does not allow extensions for appeals.

We deleted the following statement: Note: You can’t get a fast appeal if our plan
denied payment for a service you already got. This statement is inconsistent with
our guidance in the Addendum to the Parts C & D Enrollee Grievances,
Organization/Coverage Determinations, and Appeals Guidance for Applicable
Integrated Plans, sections 50.1.a and 50.7.1.a that allow expedited
reconsiderations for payment denials.

We added instructions to plans that make it optional to remove this section. Plans may
include this section even if the decision does not relate to a service/item/drug that was
approved under a previous authorization.

service/item
or Part B
drug or
Medicaid
drug during
your appeal
End of
document

To the end of the letter, we added a new nondiscriminatory language disclaimer that is
required on CMS forms and notices.