CROSSWALK (Appendix D2) 2022 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determi

All-Payer Payer Initiated Submission Form
CY 2021 Final versus CY 2022 Proposed

Burden impact: The changes to this form reflect proposals in the CY2022 Physician Fee
Schedule (PFS) Proposed Rule for the Quality Payment Program. There are no impacts to
burden as a result of these changes.
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Change #1:
Location: Page 1, Line 18
Reason for Change:
Alignment with current year.
CY 2021 Final Rule text:
2021 for the 2021
CY 2022 Proposed Rule text:
2022 for the 2023
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Change #2:
Location: Page 1, Line 24
Reason for Change:
Alignment with current year.
CY 2021 Final Rule text:
2021 for the 2022
CY 2022 Proposed Rule text:
2022 for the 2023
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Change #3:
Location: Page 1, Line 29
Reason for Change:
Alignment with current year.
CY 2021 Final Rule text:
2021 for the 2022
CY 2022 Proposed Rule text:
2022 for the 2023