Crosswalk (before 60-day)

Current CMS-10630 (2023)

Summary of Changes in Proposed CMS-10630
(starting in 2026)

AttachmentIPACEAuditProtocol, Audit
Purpose and Scope

•

AttachmentIPACEAuditProtocol, Initial
Documentation and Data Submissions

•
•

AttachmentIPACEAuditProtocol, Audit
Elements, Service Determination
Requests, Appeals, and Grievances (SDAG)

•
•
•
•
•

AttachmentIPACEAuditProtocol, Audit
Elements, Provision of Services

•
•
•
•
•

AttachmentIPACEAuditProtocol, Audit
Elements, Personnel Records

•
•
•
•

Type of
Change

Explanation of Changes

Burden
Impact

Modified purpose and scope text

Modify

Minor wording changes for clarity

None

Modified documentation for the compliance
oversight program
Removed Monitoring Reports

Modify

Clarified instructions, Changes
based on audit experience

High
(reduction)

Added references to applicable universes in
Appendix B and regulatory citations
Modified instructions for submitting case files
to CMS
Modified current documentation requests and
compliance standards
Added new documentation requests and
compliance standards
Modified instructions for submitting responses
to CMS

Modify

Technical changes, Changes due to
regulatory updates (effective June
2024), Clarified instructions

Low

Modify
Added references to applicable universes in
Appendix B and regulatory citations
Modified instructions for observations and
interviews
Added new documentation requests and
compliance standards
Modified instructions for submitting responses
to CMS
Modified current compliance standards

Technical changes, Changes due to
regulatory updates (effective June
2024), Streamlined information,
Clarified instructions

Low

Modify

Technical changes, Changes due to
regulatory updates (effective June
2024), Clarified instructions

Low

Added references to applicable universes in
Appendix B and regulatory citations
Added new documentation requests and
compliance standards
Modified instructions for submitting responses
to CMS
Modified current compliance standards

Current CMS-10630 (2023)

Summary of Changes in Proposed CMS-10630
(starting in 2026)

AttachmentIPACEAuditProtocol,
Compliance and Quality Improvement

•
•
•

Type of
Change

Explanation of Changes

Burden
Impact

Added references to universes in Appendix B
and regulatory citations
Added new documentation requests and
compliance standards
Modified instructions for submitting responses
to CMS
Added instructions for responding to requests
for additional Information regarding potential
issues non-compliance
Add instructions about data entry and
formatting

Modify

Technical changes, Clarified
instructions, Changes for clarity
based on audit experience

Low

Modify

Clarified instructions

None

Modify

Clarified instructions

None

AttachmentIPACEAuditProtocol, Analysis
of Potential Non-Compliance

•

AttachmentIPACEAuditProtocol, Appendix
A

•

AttachmentIPACEAuditProtocol, Appendix
A, Table 1: Service Determination
Requests (SDR) Record Layout

•
•

Modified record layout instructions
Modified current data fields

Modify

Technical changes, Changes for
clarity based on audit experience

None

AttachmentIPACEAuditProtocol, Appendix
A, Table 2: Appeal Requests (AR) Record
Layout

•
•

Modified record layout instructions
Modified current data fields

Modify

Technical changes, Changes for
clarity based on audit experience

None

AttachmentIPACEAuditProtocol, Appendix
A, Table 3: Grievance (GR) Record Layout
10 columns in the Record Layout

•
•
•
•

Modified record layout instructions
Modified current data fields
Removed 2 data fields
Added 8 new data fields

Modify

Technical changes, Changes due to
regulatory updates (effective June
2024), Changes for clarity based on
audit experience

Moderate

AttachmentIPACEAuditProtocol, Appendix
A, Table 4: List of Personnel (LOP) Record
Layout

•
•

Modified record layout instructions
Modified current data fields

Modify

Technical changes, Changes for
clarity based on audit experience

None

AttachmentIPACEAuditProtocol, Appendix
A, Table 5: List of Participant Medical
Records (LOPMR) Record Layout
34 columns in the Record Layout
AttachmentIPACEAuditProtocol, Appendix
A, Table 6: On-Call (OC) Record Layout

•
•
•

Modified current data fields
Removed 4 data fields
Added 3 new data fields

Modify

Low

•

Modified current data fields

Modify

Technical changes, Changes based
on audit experience, Changes due
to regulatory updates (effective
June 2024)
Technical changes

None

Current CMS-10630 (2023)

Summary of Changes in Proposed CMS-10630
(starting in 2026)

Type of
Change

Explanation of Changes

Burden
Impact

AttachmentIPACEAuditProtocol, Appendix
A, Table 7: Contracted Entities and
Providers (CEP) Record Layout
AttachmentIIPACESupplementalQuestions
(14 questions)

•
•

Modified record layout instructions
Modified current data fields

Modify

Technical changes, Changes for
clarity based on audit experience

None

•

Modify

Technical changes, Changes for
based on audit experience

Low

•
•

Modified questions to clarify the information
requested
Removed 1 question
Added 4 questions

AttachmentVCorrectiveActionPlanProcess

•
•

Modified instructions
Removed implementation submissions

Modify

Technical changes, Changes for
clarity based on audit experience

Moderate
(reduction)

CaseFileCoverSheet
(No equivalent in the current protocol)

•

Add

•

New cover sheets provide checklist
for submitting case file
documentation
New template clarifies an existing
audit process

Low

RequestAdditionInformationTemplate
(No equivalent in the current protocol)

Added cover sheets for SDAG and Personnel
case files to ensure all requested
documentation is included.
Template explains how a PACE organization
will submit information in response to
requests for information related to potential
issues of non-compliance identified during a
PACE audit.

RootCauseTemplate

RootCauseTemplate
• Added 1 column on the detailed sample
information tab

Allows for CMS assignment of an ID
number for each issue of noncompliance identified during the
audit.

None

Add

Modify

None

Current CMS-10630 (2023)

Summary of Changes in Proposed CMS-10630
(starting in 2026)

18 Impact Analyses templates

•

AlertIDT1P14 Impact Analysis
• 22 columns on participant impact tab

AlertIDT1P14 Impact Analysis:
• Removed 1 column on the participant impact
tab
• Modified 5 columns on the participant impact
tab
Appeals1P321P661P681P73 Impact Analysis:
• Renamed impact analysis
• Updated instructions tab
• Added 2 columns on the participant impact
tab
• Removed 10 columns on the participant
impact tab
• Modified 13 columns on the participant
impact tab

Appeals1P651P661P681P73 Impact
Analysis
• 42 columns on the participant impact
tab

25 Impact Analysis templates

Type of
Change

Explanation of Changes

Burden
Impact

Add

Added seven additional Impact
Analysis templates.
Four added based on new
regulatory provisions (effective
June 2023 or 2024):
ArrangingServices1P101,
ParticipantRights1P1061P107,
PlanofCare1P151P201P84, and
RequiredSpecialistContracts1P100.
Three separated out from existing
templates for clarity based on audit
experience:
AppealRecognition1P65,
Effectuation1P02,
GrievanceRecognitionandNotificati
on1P751P77
Minor wording changes for clarity,
Changes based on audit experience

Low

Minor wording changes for clarity,
Changes based on audit experience

Low

Modify

Modify

Low

Current CMS-10630 (2023)

Summary of Changes in Proposed CMS-10630
(starting in 2026)

Type of
Change

Explanation of Changes

Burden
Impact

Assessments1P491P50 Impact Analysis
• 31 columns on the participant impact
tab

Assessments1P491P50 Impact Analysis:
• Added 3 column on the participant impact tab
• Removed 12 columns on the participant
impact tab
• Modified 10 columns on the participant
impact tab

Modify

Minor wording changes for clarity,
Changes based on audit
experience, Changes to align with
new regulatory provisions
(effective June 2024)

Low

CoordinationofCare1P95
• 25 columns on the participant
impact tab
Effectuation1P021P111P30 Impact
Analysis
• 34 columns on the participant impact
tab

CoordinationofCare1P95:
• Modified 3 columns on the participant impact
tab
AppealsEffectuation1P111P30 Impact Analysis:
• Renamed impact analysis
• Updated instructions tab
• Added 2 columns on the participant impact
tab
• Removed 15 columns on the participant
impact tab
• Modified 8 columns on the participant impact
tab
EmergencyCare1P07 Impact Analysis:
• Added 1 column to the participant impact tab
• Removed 2 columns on participant impact tab
• Modified 3 columns on the participant impact
tab
Grievances Grievances1P311P1031P1041P105
Impact Analysis:
• Renamed impact analysis
• Updated instructions tab, including adding
information for new conditions
• Added 20 columns to the participant impact
tab
• Removed 14 columns on the participant
impact tab
• Modified 3 columns on the participant impact
tab

Modify

Minor wording changes for clarity

None

Modify

Minor wording changes for clarity,
Changes based on audit experience

Low

Modify

Minor wording changes for clarity

Low

Modify

Minor wording changes for clarity,
Changes based on audit
experience, Changes to align with
new regulatory provisions
(effective June 2024)

Low

EmergencyCare1P07 Impact Analysis:
• 27 columns on the participant impact
tab
Grievances1P311P751P77 Impact Analysis
• 29 columns on the participant impact
tab

Current CMS-10630 (2023)

Summary of Changes in Proposed CMS-10630
(starting in 2026)

Type of
Change

Explanation of Changes

Burden
Impact

HomeCare1P02 Impact Analysis
• 16 columns on participant impact tab

HomeCare1P02 Impact Analysis:
• Added 1 column to participant impact tab
• Removed 3 columns on the participant impact
tab
• Modified 5 columns on the participant impact
tab
MedErrors1P02 Impact Analysis:
• Modified 4 columns on the participant impact
tab
Personnel Impact Analysis:
• Updated instructions tab
• Added 9 columns on the participant impact
tab
• Removed 4 columns on the participant impact
tab
• Modified 10 columns on the participant
impact tab
ProvisionofServices1P02 Impact Analysis:
• Modified 10 columns on the participant
impact tab
RequiredServices1P931P100
• Renamed impact analysis
• Updated instructions tab
• Added 1 column on the participant impact
tab
• Removed 4 columns on the participant
impact tab
• Modified 17 columns on the participant
impact tab
Restraints1P09 Impact Analysis:
• Added 2 columns on the participant impact
tab
• Removed 5 columns on the participant impact
tab
• Modified 12 columns on the participant
impact tab

Modify

Minor wording changes for clarity

Low

Modify

Minor wording changes for clarity

Low

Modify

Minor wording changes for clarity,
Changes to align with new
regulatory provisions (effective
June 2024)

Low

Modify

Minor wording changes for clarity

Low

Modify

Minor wording changes for clarity,
Changes based on audit experience

Low

Modify

Minor wording changes for clarity,
Changes based on audit experience

Low

MedErrors1P02 Impact Analysis
• 22 columns on participant impact tab
Personnel Impact Analysis
• 24 columns on the participant impact
tab

ProvisionofServices1P02 Impact Analysis
• 19 columns on the participant impact
tab
RequiredServices1P93
• 29 columns on the participant impact
tab

Restraints1P09 Impact Analysis
• 26 columns on the participant impact
tab

Current CMS-10630 (2023)

Summary of Changes in Proposed CMS-10630
(starting in 2026)

Type of
Change

Explanation of Changes

Burden
Impact

SDRIdentification1P76 Impact Analysis
• 21 columns on participant impact tab

SDRIdentification1P76 Impact Analysis:
• Modified 6 columns on participant impact tab

Modify

Minor wording changes for clarity

Low

SDRs1P601P611P85 Impact Analysis
• 22 columns on participant impact
tab

SDRs1P041P601P611P85 Impact Analysis:
• Renamed impact analysis
• Updated instructions for completing
participant impact tab
• Added 2 columns on the participant impact
tab
• Removed 3 columns on the participant impact
tab
• Modified 14 columns on the participant
impact tab
RecommendedServices1P94
• Renamed impact analysis
• Modified the instructions tab, including
adding information for two new sections
• Added 19 columns on participant impact
tab
• Removed 11 columns on participant
impact tab
• Modified 6 columns on participant impact
tab
SrvcRestrict1P90 Impact Analysis:
• Updated instructions tab
• Added 7 columns on the participant impact
tab
• Modified 4 columns on the participant impact
tab
WoundCare1P02 Impact Analysis:
• Added 4 columns to the participant impact tab
• Removed 8 columns on the participant impact
tab
• Modified 4 columns on the participant impact
tab

Modify

Minor wording changes for clarity,
Changes based on audit experience

Low

Modify

Minor wording changes for clarity,
Changes to align with new
regulatory provisions (effective
June 2024)

Low

Modify

Minor wording changes for clarity,
Changes based on audit experience

Low

Modify

Minor wording changes for clarity,
Changes based on audit experience

Low

SpecialistRecommendations1P94
• 24 columns on participant impact
tab

SrvcRestrict1P90 Impact Analysis
• 19 columns on the participant impact
tab

WoundCare1P02 Impact Analysis:
• 24 columns on the participant impact
tab

Current CMS-10630 (2023)

Summary of Changes in Proposed CMS-10630
(starting in 2026)

CAPTemplate
(No equivalent in the current protocol)

•

Template provides instructions for submitting
corrective action plans for issues of noncompliance identified during a PACE audit.

Type of
Change

Explanation of Changes

Burden
Impact

Add

New template clarifies an existing
audit process

None