Crosswalk

CY 2022 List of Changes
CY 2022 PBP Changes
Landing Page
1. The PBP software landing page has been updated to reflect the CY2022 year change.
SOURCE: Internal
PBP SCREEN/CATEGORY: Landing Screen
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionA-Upload-2020-09-16.pdf
PAGE(S): Page 9
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: To update the year references throughout the software.
IMPACT BURDEN: No impact
Section B
2. The PBP software will be updated to remove the Acupuncture/Chiropractic combination benefit
questions in Section B: 7b, 13a, 14c17, 19B#13a
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Section B 7b Chiropractic Services, 13a Acupuncture, 14c Other Defined
Supplemental Benefits; Section B VBID VBID/UF/SSBCI 19B #13a Acupuncture – Base 1
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-2020-12-02.pdf &
Appendix_C_PBP2022_Screenshots- Section B VBID-UF-SSBCI-2020-12-02.pdf
PAGE(S): Section B Pages 70, 135, 191; Section B VBID-UF-SSBCI Page 83
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: These questions are no longer needed; this type of combined benefit
can now be addressed in the Combined Benefit Screens in Section D.
IMPACT BURDEN: Reduce/No Impact
3. The PBP software will be updated to remove “per visit” from B9a Medicare-covered Observation
Services questions and to add a question to indicate “per day,” “per stay”, or “other” if Medicarecovered Observation Services Copay is selected.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Section B9a, Outpatient Hospital Services
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-2020-12-02.pdf
PAGE(S): 107
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Benefit is not limited to “per visit” and the responses should reflect
the accurate information.
IMPACT BURDEN: No Impact
4. The PBP software will be updated to add additional questions to define Therapeutic Massage in
Section B14c “Other Defined Supplemental Benefits."
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: B14c: Other Defined Supplemental Benefits
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-2020-12-02.pdf
PAGE(S): 192

CY 2022 List of Changes
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: To more precisely capture the type of therapeutic massage benefit
offered.
IMPACT BURDEN: Slight Increase
5. The PBP software will be updated to rename the Section B4a title from “Emergency/Post
Stabilization Services” to “Emergency Services”
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: B4a Emergency Services:
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-2020-12-02.pdf;
Appendix_C_PBP2022_Screenshots- Section B VBID-UF-SSBCI-2020-12-02.pdf.
PAGE(S): Section B 52, 53; Section B VBID 13, 14, 16, 22,23,30
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: “Post-Stabilization Services” is now considered to be under Inpatient
Hospitalization, and not associated with “Emergency Services.”
IMPACT BURDEN: No Impact
6. The PBP software will be updated to ask the user to indicate type of meal benefit rather than
quantity.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: B13c Meals, B19b/13c:
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-2020-12-02.pdf &
Appendix_C_PBP2022_Screenshots- Section B VBID-UF-SSBCI-2020-12-02.pdf
PAGE(S): Section B 141; Section B VBID-UF-SSBCI 89
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Updated to capture qualitative data on meal benefit, and allow for
easier reporting by organizations.
IMPACT BURDEN: Reduces Burden
7. The PBP software will be updated to add additional questions to B14c and B19b/14c to indicate the
type of Support for Caregivers offered.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: B14c Other Defined Supplemental Benefits, VBID/UF/SSBCI 19B #14c Other
Defined Supplemental Benefits – Base 3
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-2020-12-02.pdf &
Appendix_C_PBP2022_Screenshots- Section B VBID-UF-SSBCI-2020-12-02.pdf
PAGE(S): Section B page 192, Section B VBID page 153
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Allows user to indicate the type of Support for Caregivers
IMPACT BURDEN: Slight increase/No impact
8. The PBP software will be updated to remove the selection B14e6 – “Other Medicare-Covered
Preventive Services” from the list of selection options for B14e “Other Medicare-Covered Preventive
Services”
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: B14e Other Medicare-covered Preventive Services
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-2020-12-02.pdf

CY 2022 List of Changes
PAGE(S): Section B 209, 210, 211, 212
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: “Other” category is not needed. Removing to minimize confusion
and reduce burden.
IMPACT BURDEN: Reduces/No Impact
9. The PBP software will be updated to add new screens in B19a and B19b for users to specify chronic
conditions for each SSBCI package.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: #19a Reduced Cost Sharing for VBID/UF/SSBCI – Chronic Conditions: SSBCI;
#19b Additional Benefits for VBID/UF/SSBCI – Chronic Conditions: SSBCI
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-VBID-UF-SSBCI-2020-12-02.pdf
PAGE(S): 11, 36
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Chronic condition needs to be specified for each SSBCI package.
IMPACT BURDEN: Slight Increase/No Impact
10. The PBP software will be updated to ask the user to indicate whether meal benefit is unlimited
rather than providing a specific number.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: B19b/13i Meals
DOCUMENT: Appendix_C_PBP2022_Screenshots-SectionB-VBID_UF-SSBCI-2020-12-02.pdf
PAGE(S): 105
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: To reduce burden by making the question more generic and easier to
answer.
IMPACT BURDEN: Reduces Burden
Section C
11. The PBP software will be updated to include a notes field for each OON/POS grouping.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Section C: POS Groups/OON Groups
DOCUMENT: Appendix_C_PBP2022-Screenshots-SectionC-2020-09-16.pdf
PAGE(S): 12, 27
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: To provide a notes field for users to explain certain cost sharing
conditions.
IMPACT BURDEN: Slight Increase/No Burden
Section D
12. The PBP software will be updated to add a periodicity question for maximum plan benefit amount
on for each of the Combined Benefits package screens.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Section D: Combined Benefits

CY 2022 List of Changes
DOCUMENT: Appendix_C_PBP2022-Screenshots-SectionD-2020-09-16.pdf
PAGE(S): 33-35
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: So that plans can specify maximum plan benefit amount periodicity
for each combined benefits package
IMPACT BURDEN: Slight increase/No Impact
13. The PBP software will be updated to include "every month" as an option for Reductions in Cost
Sharing periodicity.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Section D: Reductions in Cost Sharing
DOCUMENT: Appendix_C_PBP2022-Screenshots-SectionD-2020-09-16.pdf
PAGE(S): Pages 27, 29, 31
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Allow users to select “every month” as an option for specifying
periodicity.
IMPACT BURDEN: No impact
Section Rx -general
14. The PBP software will be updated to remove quantity limit, prior authorization, indication-based
formulary design, and step therapy questions that are captured elsewhere in HPMS.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Medicare Rx General
DOCUMENT: Appendix_C_PBP2022-Screenshots-SectionRx-2020-09-16.pdf
PAGE(S): 2
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: To reduce burden on plans.
IMPACT Burden: Reduce Burden

Formulary Changes
1. CMS is adding a gate opening request field to the UMGD criteria response record layout when a
change in the formulary file is required to resolve a criteria concern. Instances when a UMGD is
removed from the formulary file, or when step therapy criteria dictates changes to a formulary file,
would be examples of when a formulary file gate would be requested to be opened.
Source: CMS, Internal
Formulary Screen/Category: utilization Management Group Description (UMGD) Criteria Response
Record Layout
Document: Appendix_C_Formulary2022_UMGD_Criteria_Response_Record_Layout.pdf
PAGE(S): 1
CITATION: CMS Model
REASON WHY CHANGE IS NEEDED: Currently no indicator exists to communicate this type of request
from plans to CMS, and plans have to email this information outside the system to provide the
information.
IMPACT Burden: Reduces Burden

CY 2022 List of Changes

MTMP Changes
1. There is a requirement to place the word ‘Any’ prior to ‘Chronic/maintenance drugs apply’ option
under the ‘Type of Covered Part D Drugs’ section on the Multiple Covered Part D Drugs Page.
SOURCE: CMS, Internal
MTMP SCREEN/CATEGORY: CY 2022 MTMP - Enter/Edit Multiple Covered Part D Drugs Page
DOCUMENT: Appendix_C_MTMP_CY2022_Enhancements_Mockups.docx
PAGE(S): 1
CITATION: Lessons Learned
REASON WHY CHANGE IS NEEDED: To meet the Business requirements need
IMPACT BURDEN: No impact