Form CMS-906 Collection Instrument and Instructions

Collection Instrument and Instructions
Fiscal Soundness Reporting Requirements (FSRR)
CMS-906, OMB 0938-0469

1. Launch the web browser and enter the following URL for HPMS
(https://hpms.cms.gov/app/ng/home/). Click on Login with CMS EUA. Enter
CMS User ID and Password (Figure 1).
Figure 1: HPMS Home Page

2. On the HPMS Home Page, hover on the Monitoring link on the top navigation
panel and select Fiscal Soundness (Figure 2).
Figure 2: Accessing Fiscal Soundness Module

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3. Navigate to Financials and select Submission of Financial Information. On
the Submission of Financial Information page, select desired Contract
Number/Name or one from the contract group. Then select Next (Figure 3).
Figure 3: Submission of Financial Information Page

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4. On the Select Reporting Period Page, select Submit New under the desired
reporting period (Figure 4 or Figure 5).
Figure 4: Select Reporting Period Page (Non-PACE)

Figure 5: Select Reporting Period Page (PACE)

5. On the New Financial Submission page (Figure 6 or Figure 7), enter data
elements and upload documentation.
a. Total Assets – This total amount is found on the Balance Sheet.
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b. Total Liabilities – This total amount is found on the Balance Sheet. For
PACE or 1876 Cost Plan contracts, this amount includes
Subordinated/Guaranteed Debt.
c. Subordinated Debt/Guaranteed Debt (Included in Total Liabilities) –
PACE or 1876 Cost Plan contracts only.
Subordinated debt is defined as an unsecured debt whose repayment
to its Parent Organization ranks after all other debts have been paid
when the subsidiary files for bankruptcy. An example of subordinated
debt is when the Parent Organization loans money to the PACE
organization or Cost Plan to pay its debts. The PACE organization or
Cost Plan only needs to repay the Parent Organization after all of its
other liabilities have been satisfied.
Guaranteed debt is defined as secured debt in which another entity
promises to pay a loan or other debt if the organization that borrowed
the money fails to pay. An example of guaranteed debt is when the
PACE organization or Cost Plan obtains a loan from a bank and another
entity signs on to guarantee payment of all (or a portion of) the loan. In
the event of bankruptcy or default, the other entity will make payments
on the loan on behalf of the PACE organization or Cost Plan to ensure
the debt is satisfied.
Note:
• When a value of zero is entered, the system will alert the user.
• When entering a numeric value other than zero, users are expected
to include a signed Subordinated/Guaranteed Debt Attestation Form
zipped with their file upload. The form can be accessed by selecting
Subordinated/Guaranteed Debt Attestation Form at the bottom of the
page or in the module navigation menu.
d. Net Income (Loss) – This is the portion of revenue remaining after all
the expenses and taxes have been deducted. This amount is found as
a line item on the Revenue and Expense Statement. This amount can
also be a negative number; in that case, it's called a Net Loss.
e. Cash Flow from Operations – This amount is found on the Cash Flow
Statement. It is the first sub-totaled amount before accounting for
cash flow from investing and financing activities.
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f. File – Upload the applicable financial statement(s). Click ‘Choose file
to upload or drag the file here’ to upload a file OR drag and drop the file
into the location.
Note:
• Accepted file types are .DOC, .DOCX, .PDF, and .ZIP. Filename
cannot contain any of the following characters: pound (#), percent (%),
semi-colon (;), plus (+), ampersand (&), and double periods (..).
• Maximum file size allowed is 20MB.
• Uploaded file name length should not exceed 150 characters.
g. Subordinated/Guaranteed Debt Attestation – PACE contracts only.
When entering a numeric value other than zero, users are required to
indicate that the Subordinated/Guaranteed Debt Attestation form has
been included in their submission by selecting the
Subordinated/Guaranteed Debt Attestation checkbox.
Note:
• 1876 Cost Plans should contact CMS regarding
Subordinated/Guaranteed Debt Attestation.
Figure 6: New Financial Submission Page (Non-PACE)

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Figure 7: New Financial Submission Page (PACE)

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6. After completing all information, select Next.
7. Review the information entered on the New Financial Submission Verification
page (Figure 8 or Figure 9).
a. If changes need to be made, select Back.
b. If the information is correct, select Submit.
Figure 8: Verify Financial Information Page (Non-PACE)

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Figure 9: Verify Financial Information Page (PACE)

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8. An attestation of the submission is required (Figure 10). Select OK.
Figure 10: New Submission Attestation Popup (Audited Annual)

9. Upon submission, the Confirmation page is displayed (Figure 11).
Figure 11: Confirmation Page

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