Appendix F2 (See Table 29): 2022 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option Crosswalk

All-Payer QP Data Submission Form
CY 2021 Final versus CY 2022 Final

Burden impact: The changes to this form reflect policies 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 33
Reason for Change:
2021 Threshold changed through statute.
CY 2021 Final Rule text:
75
CY 2022 Final Rule text:
50
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Change #2:
Location: Page 1, Line 33
Reason for Change:
2022 Threshold changed through statute.
CY 2021 Final Rule text:
75
CY 2022 Final Rule text:
50
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Change #3:
Location: Page 1, Line 34
Reason for Change:
Threshold changed to reflect statute.
CY 2021 Final Rule text:
40
CY 2022 Final Rule text:
50
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Change #4:
Location: Page 2, Line 6
Reason for Change:
2021 Threshold changed through statute.
CY 2021 Final Rule text:
50
CY 2022 Final Rule text:
35

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Change #5:
Location: Page 2, Line 6
Reason for Change:
2022 Threshold changed through statute.
CY 2021 Final Rule text:
50
CY 2022 Final Rule text:
35
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Change #6:
Location: Page 2, Line 7
Reason for Change:
2022 Partial QP Patient Count Threshold changed through statute.
CY 2021 Final Rule text:
35.
CY 2022 Final Rule text:
25
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Change #7:
Location: Page 4, Line 26
Reason for Change:
Year updated.
CY 2021 Final Rule text:
2019
CY 2022 Final Rule text:
2022
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Change #8:
Location: Page 4, Line 26
Reason for Change:
Year updated.
CY 2021 Final Rule text:
Note: Only participants in the Medicare Shared Savings Program may submit data at the
TIN level for performance year 2019.
CY 2022 Final Rule text:
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Change #9:
Location: Page 6, Line 7
Reason for Change:
Year updated.
CY 2021 Final Rule text:
2021

CY 2022 Final Rule text:
2022
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Change #10:
Location: Page 6, Line 28
Reason for Change:
Year updated.
CY 2021 Final Rule text:
January 1, 2021-June 30, 2021
CY 2022 Final Rule text:
January 1, 2022-June 30, 2022
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Change #11:
Location: Page 7, Line 26
Reason for Change:
Year updated.
CY 2021 Final Rule text:
January 1, 2021-June 30, 2021
CY 2022 Final Rule text:
January 1, 2022-June 30, 2022
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Change #12:
Location: Page 7, Line 42
Reason for Change:
Year updated.
CY 2021 Final Rule text:
January 1, 2021-June 30, 2021
CY 2022 Final Rule text:
January 1, 2022-June 30, 2022