Attachment 2 – Crosswalk for Model Precluded Provider Letter

Crosswalk for Model Precluded Provider Letter
2019 (old version)
2021 (new version)

Type of
Change
Rev

Title of document

Changed “sample” to “model”

Instructions

Added language to emphasize that use of the letter is Rev
optional

Title

Removed year “2019” since letter is not specific to
year.
Updated website link to:
https://www.cms.gov/Medicare/ProviderEnrollment-and-Certification/Preclusion-List

CMS preclusion list
website:
https://www.cms.gov/
Medicare/ProviderEnrollment-andCertification/Me
dicareProviderSupEnr
oll/PreclusionList.html

Reason for change

Rev

Accuracy,
consistency with
regulatory language
at 42 CFR §
423.2267 with
respect to model vs.
standardized
documents
Revised based on 60day comment to
minimize ambiguity
surrounding forms
that are not
standardized but bear
an OMB control
number
Clarity

Rev

Accuracy

Burden
Change
No

No

No
No

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This pre-decisional, privileged,
and confidential information is for internal government use only, and must not be disseminated, distributed, or copied to persons not
authorized to receive the information. For Preliminary discussion only, pending review of all public comments. Unauthorized disclosure
may result in prosecution to the full extent of the law.