ICR Documents

Supporting Statement A Document Date Uploaded CMS-10453 - Supporting Statement A final.docx 02/26/2024 Supporting Statement B Document Date Uploaded Supplementary Documents Title Document Document Type Date Uploaded Crosswalk Part D Model EOB Crosswalk.pdf Supplementary Document 02/26/2024 Response to Comments Document Comments Received 2025 EOB PRA Package 60 day.pdf Supplementary Document 12/18/2023 Response to Comments Document - 30 Day Comments Received 2025 EOB PRA Package 30 day.pdf Supplementary Document 02/26/2024 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received Ortega, Erika MCS's Grievances and Appeals Proposed EOB comment.docx Other -- Reginfo.gov Simple 01/08/2024 01/08/2024 Anonymous 60 Day Comments.pdf Email Multiple 12/18/2023 12/18/2023 Ortega, Erika PC_202312-0938-004_010824_034159_1.pdf Other -- Reginfo.gov Simple 01/08/2024 01/08/2024 Schulman, Melissa PC_202312-0938-004_010824_112258_1.pdf CVSH CY 2025 Explanation of Benefits Comments 1_8_2024 FINAL.pdf CVS Health Other -- Reginfo.gov Simple 01/08/2024 01/08/2024 Ruiz, Erica PC_202312-0938-004_123023_023700_1.pdf Other -- Reginfo.gov Simple 12/30/2023 12/30/2023