Crosswalk: Facility HSD Table Template

Number

1

2
3
4

Form

Change

Current Location

Removed column "Facility or Service
Facility HSD Table Type"
Column B
Added clarification to column "Letter
of Intent": "Letter of Intent? (Y/N)
Facility HSD Table Only applicable for MA Applicants" column M
Removed column "Uses CMS MA
Facility HSD Table Contract Amendment? (Y/N)"
column K
Moved Column "*# of Staffed,
Facility HSD Table Medicare-Certified Beds"
column E

Reason
Operational update to remove duplicative data entry. The Facility
or Service Type column required a MAO to enter the specialty
type name with each submission. MAOs are required to enter the
facility type Specialty Code that captures the same information.

Additional clarification that this column is only to be completed by
applicants.
Previously collected data, not currently used in Network Adequacy
reviews.
Improve logical flow of data entry by MAOs.