CROSSWALK: MCO Annual Surveys

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Updated grammar and formatting of questions for
easier understanding.

Rev

To make it easier for respondent to
complete the survey. Updated grammar,
Decrease work burden for respondents by 5 min.
sentence structure and formatting for easier
understanding.

Spelled out acronyms for easier understanding.

Rev

To make it easier for respondent to
complete the survey by identifying
acronyms.

Decrease work burden for respondents by 5 min.

Add

Incorporated statement in introduction to
increase respondent understanding that
their responses will not be altered when
reporting out.

No burden change.

Del

As survey (backend) IT requirements
changed, this statement was not needed.

No burden change.

Section I, Demographics - removed telephone number

Rev

Removed telephone number as not needed
and replaced with Postion Title

No burden change.

Section II. ProDUR, Question 2, question clarified

Rev

Question revised for ease of understanding
Decrease work burden for respondents by 5 min.
to the respondent.

Section II. ProDUR, Question 4. "No" explanation
required.

Add

Documented explanation required for this
question.

Section II. ProDUR, Question 9. Does your system
have a diagnosis edit that can be utilized when
processing a prescription? Please explain.

Add

Querying respondents to confirm that a
diagnosis edit is included in their DUR
Increase work burden for respondents by 10 min.
criteria as diagnoses play an important role
for FDA approved indications for drugs.

Section II. ProDUR, Question 10, question clarified

Rev

Question revised for ease of understanding
Decrease work burden for respondents by 5 min.
to the respondent.

Add

Added question to provide oversight to
requirements

Increase work burden for respondents by 20 min.

Rev

For clarity

Decrease work burden for respondents by 15 min.

Section VII. Program Evalution/Cost Savings/Cost
Avoidance - Section added for oversight

Add

Added section to provide oversight to
requirements and match the FFS survey
oversight

Increase work burden for respondents by 180 min.

Section VIII. FWA, A. Lock-in or PRR, Question 1.

Add

The "No" response requires an explanation. Increase work burden for respondents by 10 min.

Section VIII. FWA, A. Question 2.e. Revision

Rev

Updated question for ease of understanding
and response option of n/a to decrease
Decrease work burden for respondents by 20 min.
workload

Section VIII. FWA, A. Added Question - Briefly
explain the MCOs objectives and scope of
responsibility between DUR and SUR functions as
they relate to FWA. Additionally, explain how the
MCO maintains separation between fraud and abuse

Add

Added question to maintain oversight to
requirements

Opening Introduction to survey: CMS does not edit
State responses; therefore, what is submitted will be
what is posted on Medicaid.gov. This material is
also utilized for composing the annual report to
CongressIntroduction to survey: IMPORTANT
Opening
NOTE: Please download a copy of the survey to your
desktop before starting or distributing the survey.
Adobe Acrobat Reader must be used to edit the
survey. The MCO survey cannot be edited within a
browser window Adobe Acrobat Reader must be

Section II. ProDUR, Question 12, Added question for
oversight - Section 1927(g)(A) of the Act requires
that the pharmacist offer patient counseling at the
time of dispensing. Who in your program has
responsibility for monitoring compliance with the
Section VI. Generic Policy and Utilization Data,
Question 4. How many multi-source drugs have the
innovator as the preferred drug product based on net
pricing (brand preferred over generic)?

Increase work burden for respondents by 10 min.

Increase work burden for respondents by 20 min.

Section VIII. FWA, B. PDMP - Section reorganized as
mandatory reporting is required with FFY 2023 data.

Rev

To more efficiently follow the flow of
Section 5042 of the SUPPORT Act
mandatory DUR questions.

Increase work burden for respondents by 25 min.

Section VIII. FWA, B. PDMP - Removed Question 1.
d.

Del

Question not relevent to SUPPORT Act
Section 5042

Decrease work burden for respondents by 10 min.

Section VIII. FWA, B. PDMP - Question 3

Rev

Question clarification

No burden change.

Section VIII. FWA, B. PDMP - Added Question 4.c.i.

Add

Added sub part question for clarity

Increase work burden for respondents by 5 min.

Section VIII. FWA, B. PDMP - Updated Questions 4.
d., e., f. and g

Rev

Updated questions for clarity and
understanding

No burden change.

Add

Adding additional question to follow
Section 5042 of the SUPPORT Act.

Increase work burden for respondents by 10 min.

Add

Adding additional question to follow
Section 5042 of the SUPPORT Act.

Increase work burden for respondents by 5 min.

Add

As some MCOs carve out opioids, this
question is needed - If carved out, burden
would be decreased as this opioid section
would not have to be completed.

Decrease work burden for respondents by 30 min.

Rev

Text revision for ease and clarity of
responses.

Decrease work burden for respondents by 5 min.

Rev

Text revision for ease and clarity of
responses.

No burden change.

Section VIII. FWA, C. Opioids - Question 8.
Removed "Yes" POS Edits.

Rev

For clarity.

Decrease work burden for respondents by 5 min.

Section VIII. FWA, C. Opioids - Question 9.
Removed "Yes" explanation.

Rev

For clarity.

Decrease work burden for respondents by 5 min.

Section VIII. FWA, C. Opioids - Question 10.
Removed "Yes" explanation.

Rev

For clarity.

Decrease work burden for respondents by 5 min.

Section VIII. FWA, C. Opioids - Question 12Updated to current reference

Rev

Clinical Practice Guideline for Prescribing
Opioids for Pain reference updated from
No burden change.
2016 to 2022

Section VIII. FWA, C. Opioids - Question 13, "No"
explanation required.

Add

Documented explanation required for this
question.

Increase work burden for respondents by 10 min.

Section VIII. FWA, C. Opioids - Question 14

Rev

For clarity. COVID-19 removed as no
longer public emergency.

No burden change.

Section VIII. FWA, D. MME - Question 1.a - Revised
response options

Rev

Revised response options for better detail

no burden change.

Section VIII. FWA, B. PDMP - Added Question 4.j.
Has your State exempted certain individuals, (see the
definition of Covered Individuals under section
1944(h)(2) of the Act, as added by Section 5042 of
the SUPPORT Act) from the associated reporting
Section VIII. FWA, B. PDMP - Added Question 5.
Have any changes to your State’s PDMP during this
reporting period improved or detracted from the
Medicaid program’s ability to access PDMP data?
Section VIII. FWA, C. Opioids - Added Question 1.
For your program, is this category of medications
carved out and handled by the State? and
explanation .
Section VIII. FWA, C. Opioids - Revision Question 3.
Does your MCO have POS edits in place to limit the
quantity dispensed of opioids?
Section VIII. FWA, C. Opioids - Revision Question
11. Does your MCO have POS safety edits or
perform automated respective claims review and/or
provider education in regard to beneficiaries with a
diagnosis or history of opioid use disorder (OUD) or

Section VIII. FWA, D. MME - Question 1.b Clarified question
Section VIII. FWA, D. MME - Question 2. "No"
explanation required.
Section VIII. FWA, E. OUD - Question 1. "No"
explanation required.
Section VIII. FWA, E. OUD - Question 8. Updated
Section VIII. FWA, G. Psychotropic Medication Questions 3 and 4 added
Section VIII. FWA, G. Psychotropic Medication Questions 1, 3, 5, 6 and 7 restructured to allow for an
additional response - Covered through the FFS
benefit .
Section VIII. FWA, G. Psychotropic Medication Questions 2.a.b. / 4a b. / 5a.b. / 6a.b. / 7a.b.

Rev
Add
Add
Rev
Add
Rev

Rev

Clarified question for ease of undestanding no burden change.
Documented explanation required for this
question.
Documented explanation required for this
question.
Text revision for ease and clarity for
response.
Added to comply with 2024 CAA Section
203 requirement

Increase work burden for respondents by 10 min.
Increase work burden for respondents by 10 min.
No burden change.
Increase work burden for respondents by 20 min.

This additional response will allow for less
burden in completing follow up questions if Decrease work burden for respondents of 30 min.
not Covered through the FFS benefit .
Clarified these related questions for ease of
Decrease work burden for respondents by 5 min.
undestanding
Total:
Increase 175 min workload