Appendix D2 (See Table 27): 2022 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) Crosswalk

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

Burden impact: The changes to this form reflect proposals in the CY 2022 Physician Fee
Schedule (PFS) Final 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 Final 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 Final 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 Final Rule text:
2022 for the 2023