Appendix J Crosswalk

1

A

B

C

D

E

F

Reporting
Section

CY 2020 DV (2019 Reporting
Requirements)

CY 2022 DV (2021 Reporting
Requirements)

Type of
Change

Reason for
Change

Burden
Change

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:

Update

Consistent with
current technical
guidance.

Part D MTM

RSC 3a, cell D 200 references Data Elements Cell D200 references Data Element A
A-J, L-Z

2
3

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.

Part D CDR

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 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

Update

Consistent with
current technical
guidance.
Consistent with
current technical
guidance.

Update

None

None

None

4

5

6

Consistent with
current technical
guidance.
Update

None

Consistent with
current technical
guidance.
Update

None

1

A

B

C

D

E

F

Reporting
Section

CY 2020 DV (2019 Reporting
Requirements)

CY 2022 DV (2021 Reporting
Requirements)

Type of
Change

Reason for
Change

Burden
Change

Update

Consistent with
current technical
guidance.

RSC 8-biii: Includes all coverage
determination or appeal requests.

7 Part D DUR

RSC 8biii: Includes all coverage
determination or appeal requests subject
to the opioid naïve edit.

None