Crosswalk (After 60-day)

ANOC-EOC instrument crosswalk 30-day 11.24.25.pdf

Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integrated Materials (CMS-10824)

Crosswalk (After 60-day)

OMB: 0938-1444

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CMS-10824 Collection Instrument Change Crosswalk: High Level Summary of Revisions
for ANOC and EOC
For the 2026 contract year, Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)
standardized documents have been revised to reflect policy changes and simplify information for
plan members. Changes to the ANOC and each of the 12 chapters of the EOC are detailed below,
except for routine changes to the documents adjusting applicable dates, minor grammatical
changes, URLs, and other non-substantive word changes. The changes will not result in
additional burden, unless noted in the column titled “effect on burden.”
Annual Notice of Change
Location of
Change
Introduction,
diamond bullet
12
E2. Changes to
drug costs subheader

Description of Change

Reason for Change

Added instructions regarding
permissible alterations to document

G2. 4. You can
change to:
H5. The
Medicare
Prescription
Payment Plan
Appendix A

Changed the reference to section A
to the correct section which is G2
Updated language in the second
sentence for clarity.

Language added per
updates to Medicare
Advantage models
Requested by
commenter to provide
additional information
to enrollees
Updated for accuracy

Added language describing Extra
Help and the LIS Rider

Effect on
Burden
No effect
No effect

No effect

Language updated per
updates to Medicare
Advantage models

No effect

Appendix added per
updates to Medicare
Advantage models

No effect

Description of Change

Reason for Change

Added instructions regarding
permissible alterations to document

Language added per
updates to Medicare
Advantage models
Some states may have
a one moth gap in the
coverage beginning
date for Medicaid,
depending on the date
of the month the
person was enrolled in
the plan.

Effect on
Burden
No effect

Added an Appendix A that includes
operational guidance for the plans

Chapter 1: Member Handbook
Location of
Change
Introduction,
diamond bullet
12
C. Advantages
of our plan

Added a bullet to include at the end
of the section, as applicable,
describing that the Medicaid start
date could be different than the
Medicare coverage start date.

No effect

E. What makes
you eligible to
be a plan
member

Updated the sixth bullet to provide
additional information regarding
the status of Medicaid benefits
during a deeming period including
options for when Medicaid benefits
aren’t covered during the deeming
period vs when they are covered
during the deeming period.

Language added to
more fully explain
Medicaid benefits
during deeming.

H.

Update made per
changes to Medicare
Advantage models
Allows for variability
when only one
assistance program
applies.
Allows plans not
providing optional
supplemental benefits
to accurately describe
coverage.
Updated the first sentence from, “If Helps to clarify that
you’re participating in the Medicare the bill will come from
Prescription Payment Plan, you’ll
the D-SNP.
get a bill from your plan for your
drugs (instead of paying the
pharmacy).” To “If you’re
participating in the Medicare
Prescription Payment Plan, you’ll
get a bill from our plan for your
drugs (instead of paying the
pharmacy).”

No effect

Changed section title from, “Your
monthly costs for ” to
“Summary of Important Costs”
H. Summary of Added variable to the second
Important
paragraph, consistent with the first
Costs
paragraph, to accommodate when
there is only one program available.
H3. Optional
Added instruction at beginning of
Supplemental
the section noting that plans with
Benefit
no optional supplemental benefits
Premium
should delete the section.

No effect

H4. Medicare
Prescription
Payment
Amount

No effect

No effect

No effect

Chapter 2: Important phone numbers and resources
Location of
Change

Description of Change

Reason for Change

Effect on
Burden
No effect

Chapter 3: Using our plan’s coverage for your health care and other covered services
Location of
Change

Description of Change

Chapter 4: Benefits chart

Reason for Change

Effect on
Burden
No effect

Location of
Change
C. About our
plan’s benefit
chart
C. About our
plan’s benefit
chart
C. About our
plan’s benefit
chart
C. About our
plan’s benefit
chart
C. About our
plan’s benefit
chart

C. About our
plan’s benefit
chart
C. About our
plan’s benefit
chart
D. Chronic
Pain
Management
and Treatment
Services
D. Colorectal
Cancer
Screening
D. Help With
Certain
Chronic
Conditions

Description of Change

Reason for Change

In the first sentence, added optional
language noting that the chart tells
what you pay out of pocket for each
service.
In the fourth bullet added sentence,
“This means that you pay the
provider in full for out-of-network
services you get.”

The update more
accurately describes
what is included in the
chart.
Language added more
fully explains
requirement to use a
network provider, if
applicable.
Consistent with
Medicare Advantage
model description.
Consistent with
Medicare Advantage
model description.

Added bullet noting that the plan
covers everything that Original
Medicare covers.
Added bullet noting that if
Medicare adds coverage for new
services, the plan will cover the
services.
Added bullets to provide options
for additional information regarding
the status of Medicaid benefits
during a deeming period including
options for when Medicaid benefits
aren’t covered during the deeming
period vs when they are covered
during the deeming period.
Added language describing MA
Uniformity Flexibility benefits, if
applicable.
Updated description of the Special
Supplemental Benefits for the
Chronically Ill
In the “what you pay” column,
added language stating that cost
sharing will vary depending on the
course of treatment.
Made several updates to coverage
of benefit.
Updated description of coverage

Effect on
Burden
No effect

No effect

No effect
No effect

Language added to
more fully explain
Medicaid benefits
during deeming.

No effect

Consistent with
Medicare Advantage
model description
Consistent with
Medicare Advantage
model description
Consistent with
Medicare Advantage
coverage

No effect

Consistent with
Medicare Advantage
coverage
Consistent with
Medicare Advantage
coverage

No effect

No effect
No effect

No effect

D. Smoking
Updated description of coverage
and Tobacco
Use Cessation
D. Special
Updated description of coverage
Supplemental
Benefits for
the Chronically
Ill

Consistent with
Medicare Advantage
coverage description
Consistent with
Medicare Advantage
coverage description

No effect

Description of Change

Reason for Change

Added sentence describing
preferred cost sharing for
pharmacies.

Describes how
enrollees can have
lower cost sharing by
using certain
pharmacies, if
applicable.

Effect on
Burden
No effect

No effect

Chapter 5: Getting your outpatient drugs
Location of
Change
A1. Filling
your
prescriptions at
network
pharmacies

Chapter 6: What you pay for your Medicare and Medicaid program [name] drugs
Location of
Change
C. Drug
Payment
Stages

Description of Change

Reason for Change

In the second paragraph added
language clarifying that how much
they pay depends on the enrollee’s
level of Extra Help

Clarifying this
information since the
section includes a
range for LIS levels

Effect on
Burden
No effect

Chapter 7: Asking us to pay [plans with cost sharing, insert: our share of] a bill you got for
covered services or drugs
Location of
Change

Description of Change

Reason for Change

Effect on
Burden

Description of Change

Reason for Change

Added instruction stating that plans
are permitted to add the Notice of
Privacy Practices as required under
the HIPPA Privacy Rule

Consistent with
Medicare Advantage
model

Effect on
Burden
No effect

Chapter 8: Your rights and responsibilities
Location of
Change
C. Our
responsibility
to protect your
personal health
information

Chapter 9. What to do if you have a problem or complaint (coverage decisions, appeals,
complaints)
Location of
Change
B1. For more
information or
help

Description of Change

Reason for Change

Added a section describing how
enrollees can receive help from the
plan.

B1. For more
information or
help
E. Coverage
decision and
appeals
F3. Making a
level 1 appeal

Updated the description of the
SHIP to add website information.

F3. Making a
level 1 appeal

Under the heading, “These are
deadlines for a fast appeal” added
language describing how the plan
will communicate a denial of a fast
appeal.
For the fourth bullet under the
statement, “If you had a standard
appeal at level 1, you also have a
standard appeal at level 2” added
the word “can’t” to clarify that the
IRO can’t take extra time if the
request is for a Medicare Part B
drug.
In the second paragraph for the
Medicare phone number added it is
available 24 hours a day, 7 days a
week.

Added the language to
point out that plans
can be a source of help
for enrollees
Provides additional
source of assistance
for enrollees.
Provides additional
information for
enrollees.
Provides additional
information regarding
what types of services
can be appealed.
Provides additional
information regarding
the fast appeal
process.

F4. Making a
level 2 appeal

H1. Learning
about your
Medicare
rights

Added language to the end of the
first sentence further describing
coverage decisions and appeals.
Updated the first sentence to add
language to further describe the
appeal.

Effect on
Burden
No effect

No effect
No effect
No effect

No effect

The appropriate word
was missing in the
sentence

No effect

Reinforces that the
enrollee can contact
someone at Medicare
at any time.

No effect

Description of Change

Reason for Change

After the second set of bullets, we
updated the paragraph to allow the
plan to describe any differences in
the end date of Medicaid, if
applicable.

Allows plans to more
accurately describe the
coverage if someone
disenrolls from the
plan.

Effect on
Burden
No effect

Chapter 10: Ending your membership in our plan
Location of
Change
A. When You
Can End Your
Membership in
Our Plan

Chapter 11: Legal notices
Location of
Change

Description of Change

Reason for Change

Effect on
Burden

Chapter 12: Definitions of important words
Location of
Change
Rehabilitation
services
definition

Description of Change

Reason for Change

Added description of the types of
services included as rehabilitation
services.

Consistent with
Medicare Advantage
model

Effect on
Burden
No effect


File Typeapplication/pdf
File TitleCMS-10796 Collection Instrument Change Crosswalk: Changes to D-SNP State Medicaid Agency(ies) Contract(s)
SubjectSMAC PRA Collection Instrument Crosswalk
AuthorCMS-MMCO
File Modified2025-12-09
File Created2025-12-05

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