Crosswalk (after 60-day comment)

CMS-10716 Collection Instrument Change Crosswalk: Applicable Integrated Plan Coverage Decision Letter

Location of Change	Description of Change	Reason for Change	Effect on Burden
You have the right to appeal our decision	Added language that explains the appeal deadline includes a standard and fast appeal	The change was made in response to a commenter from 60-day comment period requesting that the appeal rights section align with National Committee for Quality Assurance (NCQA) guidelines.	No effect on burden
Throughout the document	Added “and/or” to “medical service/item and/or Medicare Part B drug”	The change was made in response to a commenter from the 60-day comment period, noting there may be instances where both medical service/item and Part B drug are applicable.	No effect on burden

CMS-10716 Collection Instrument Change Crosswalk: Form Instructions for Applicable Integrated Plan Coverage Decision Letter

Location of Change	Description of Change	Reason for Change	Effect on Burden
Throughout the document	Added “and/or” to “medical service/item and/or Medicare Part B drug”	The change was made in response to a commenter from the 60-day comment period, noting there may be instances where both medical service/item and Part B drug are applicable.	No effect on burden