Appendix B Crosswalk

Reporting
Section

CY 2020 DV (2019 Reporting
Requirements)

CY 2022 DV (2021 Reporting
Requirements)

Part C
Grievances

RSC 7: Organization accurately calculates the
number of grievances by category for which it
provided timely notification of the decision,
including the following criteria:

RSC 7: Organization accurately calculates
the number of grievances for which it
provided timely notification of the decision,
including the following criteria:

Part D CDR

RSC 6a.: Includes all coverage determinations
(fully favorable, partially favorable, and
adverse), including exceptions, with a date of
decision that occurs during the reporting
period, regardless of when the request for
coverage determination was received.

RSC 6a.: Includes all coverage
determinations (fully favorable, partially
favorable, and adverse), including
exceptions, with a date of decision that
occurs during the reporting period. Date of
the final decision is based on the date the
enrollee/enrollee’s representative is notified
in writing of the coverage determination
decision.

Part D CDR

RSC 7a.: Includes all decisions made (fully
favorable, partially favorable, and adverse)
with a date of decision that occurs during the
reporting period, regardless of when the
exception request was received.

RSC 7a.: Includes all decisions made (fully
favorable, partially favorable, and adverse)
with a date of decision that occurs during
the reporting period. Date of the final
decision is based on the date the
enrollee/enrollee’s representative is notified
in writing of the exception decision.

RSC 10a.: Includes all redetermination final
decisions for Part D drugs with a date of final
decision that occurs during the reporting
period, regardless of when the request for
redetermination was received or when the
member was notified of the decision.

RSC 10a.: Includes all redetermination final
decisions for Part D drugs with a date of of
final decision that occurs during the
reporting period. Date of the final decision
is based on the date the enrollee/enrollee’s
representative is notified in writing of the
redetermination decision.

Part D CDR

Part D DUR

RSC 8-biii: Includes all coverage determination RSC 8-biii: Includes all coverage
or appeal requests.
determination or appeal requests subject to
the opioid naïve edit specific to same drug
and date.

Type of Change Reason for Change

Burden
Change

Consistent with current
technical guidance.
Update

None

Consistent with current
technical guidance.

Update

None

Consistent with current
technical guidance.
Update

None

Consistent with current
technical guidance.
Update

Update

None

Consistent with current
technical guidance.

None