[Federal Register Volume 86, Number 189 (Monday, October 4, 2021)]
[Rules and Regulations]
[Pages 54631-54636]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-21546]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 412

[CMS-1750-CN]
RIN 0938-AU40


Medicare Program; Fiscal Year (FY) 2022 Inpatient Psychiatric 
Facilities Prospective Payment System and Quality Reporting Updates for 
Fiscal Year Beginning October 1, 2021 (FY 2022); Correction

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical errors that appeared in the 
final rule published in the Federal Register on August 4, 2021 entitled 
``Medicare Program; FY 2022 Inpatient Psychiatric Facilities 
Prospective Payment System and Quality Reporting Updates for Fiscal 
Year Beginning October 1, 2021 (FY 2022)''.

DATES: This correction is effective October 1, 2021.

FOR FURTHER INFORMATION CONTACT: 
    Lauren Lowenstein, (410) 786-4507 for information regarding the 
Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program.
    The IPF Payment Policy mailbox at [email protected] for 
general information.
    Nicolas Brock, (410) 786-5148 or Theresa Bean (410) 786-2287, for 
information regarding the outlier fixed dollar loss threshold amount 
and the regulatory impact analysis.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2021-16336 of August 4, 2021 (86 FR 42608), there were a 
number of technical errors that are identified and corrected in this 
correcting document. The provisions in this correction document are 
effective as if they had been included in the document published on 
August 4, 2021. Accordingly, the corrections are effective October 1, 
2021.

II. Summary of Errors

A. Summary of Errors in the Preamble

1. Inpatient Psychiatric Facilities Prospective Payment System (IPF 
PPS) Corrections
    There was a technical error in the simulation of Inpatient 
Psychiatric Facilities (IPF) payments that affected the impact analysis 
and the calculation of the final outlier fixed dollar loss threshold 
amount. In estimating the percentage of outlier payments as a 
percentage of total payments, we inadvertently applied provider 
information from the January, 2021 update of the Provider-Specific File 
(PSF) instead of the most recently available update from April, 2021. 
For fiscal year (FY) 2022, we finalized our proposal to update the IPF 
outlier threshold amount using FY 2019 claims data and the same 
methodology that we used to set the initial outlier threshold amount in 
the Rate Year 2007 IPF PPS final rule (71 FR 27072 and 27073). In 
accordance with that longstanding methodology, the calculation of 
estimated outlier payments should have used the April, 2021 provider 
information rather than the January, 2021 provider information.
    As a result of the error in estimating outlier payments, the FY 
2022 IPF PPS final rule overstated the estimate of increased transfers 
from the federal government to IPF providers. We estimated $80 million 
in increased transfers from the federal government to IPF providers; 
however, based on the corrected calculation of the outlier fixed dollar 
loss threshold amount, the correct estimate of increased transfers from 
the federal government to IPF providers should be $70 million. Also, as 
a result of the error in estimating outlier payments, the FY 2022 IPF 
PPS final rule incorrectly estimated and described the impact of the 
final rule on various provider types and the total number of providers 
included in the analysis.
    On page 42608, in the third column, second bullet, seventh sub-
bullet, the fixed dollar loss threshold amount should be changed from 
``$14,470'' to ``$16,040''.
    On page 42609, the table summarizing Total Transfers and Cost 
reductions should reflect the corrected estimate of increased payments 
to IPFs during FY 2022, which should be corrected from $80 million to 
$70 million.
    On page 42623, in the third column, in the third full paragraph, we 
incorrectly stated that IPF outlier payments as a percentage of total 
estimated payments were approximately 1.9 percent in FY 2021. The 
correct percentage should be 2.1 percent.
    On page 42623, in the third column, in the third full paragraph, we 
incorrectly stated that we were decreasing the outlier threshold amount 
to $14,470. The correct update to the outlier threshold amount should 
be increased to $16,040.
2. Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program 
Corrections
    On page 42634, in footnote 93, we made a typographical error and 
listed the date information was accessed as July 6 instead of July 16.
    On page 42645, in the second column in the first full paragraph, we 
inadvertently omitted several words from the phrase ``is this measure's 
objective'' which should read ``is not this measure's primary 
objective''.
    On page 42647, in footnote 154, we inadvertently omitted the end of 
the footnote, which should read, ``., Alcohol: A probable risk factor 
of COVID-19 severity, 7-20-2021. doi:10.1111/add.15194''.
    On page 42649, in the third column, in the first full paragraph, we 
made a typographical error and referred to ``a comprehensive program to 
address topped out'' instead of ``a comprehensive program to address 
tobacco use''.
    On page 42657, in the last paragraph under subsection b, we 
inadvertently included the phrase ``to no longer require facilities. . 
.''.
    On page 42659, in Table 7, we inadvertently included the ``Timely 
Transmission of Transition Record (Discharges from an Inpatient 
Facility to Home/Self Care or any Other Site of Care)'' in the table.
    On page 42661, in the last paragraph, last sentence, under V. 
Collection of Information Requirements, we inadvertently stated ``We 
have not made any changes from what was proposed.''
    On page 42669, in Table 15, we made a typographical error and 
listed the annual cost update for the removal of the Timely 
Transmission of Transition Record (Discharges from an Inpatient 
Facility to Home/Self Care or Any Other Site of Care) and the total 
cost update as (10,199,836.5050) instead of (10,199,836.50).
3. Regulatory Impact Analysis Corrections
    On page 42672, in the second column, we incorrectly stated that 
``we estimate that the total impact of these changes for FY 2022 
payments compared to FY 2021

[[Page 54632]]

payments will be a net increase of approximately $80 million. This 
reflects an $75 million increase from the update to the payment rates 
(+$100 million from the 2nd quarter 2021 IGI forecast of the 2016-based 
IPF market basket of 2.7 percent, and -$25 million for the productivity 
adjustment of 0.7 percentage point), as well as a $5 million increase 
as a result of the update to the outlier threshold amount. Outlier 
payments are estimated to change from 1.9 percent in FY 2021 to 2.0 
percent of total estimated IPF payments in FY 2022''. This paragraph 
should be revised to reflect that outlier payments are estimated to 
change from 2.1 percent in FY 2021 to 2.0 percent in FY 2022, and that 
the update to the outlier threshold will result in a $5 million 
decrease and a net increase of approximately $70 million in FY 2022 
payments.
    On page 42672 in the third column, in the fourth full paragraph 
under C. Detailed Economic Analysis, ``$80 million'' should be replaced 
with ``$70 million'' and ``$5 million increase'' should be replaced 
with ``$5 million decrease''.
    On pages 42674 and 42675, Table 18 reflects the impact to providers 
of updating the outlier fixed dollar loss threshold amount based on the 
inaccurate calculation of estimated FY 2021 outlier payments; 
therefore, Table 18 should be updated to reflect the correct 
calculations.
    On page 42675 in the first column, in the second full paragraph 
under 3. Impact Results, we incorrectly stated that the number of IPFs 
included in the analysis for FY 2019 claims is 1,519. The correct 
number is 1,520 IPFs.
    On page 42675, in the first column, in the third full paragraph, we 
incorrectly stated that ``Based on the FY 2019 claims, we would 
estimate that IPF outlier payments as a percentage of total IPF 
payments are 1.9 percent in FY 2021.'' The correct percentage should be 
2.1 percent.
    On page 42675, in the second column, in the first full paragraph, 
we incorrectly stated that ``Based on the FY 2019 claims, the estimated 
change in total IPF payments for FY 2022 would include an approximate 
0.1 percent increase in payments because we would expect the outlier 
portion of total payments to increase from approximately 1.9 percent to 
2.0 percent.'' This should be corrected to reflect that the estimated 
change in total IPF payments for FY 2022 would include an approximate 
0.1 percent decrease in payments because we would expect the outlier 
portion of total payments to decrease from approximately 2.1 percent to 
2.0 percent.
    On page 42675, in the second column, in the second full paragraph 
and continuing into the first paragraph of the third column, we 
incorrectly stated the overall impact and the impact to certain 
provider types due to updating the outlier fixed dollar loss threshold 
amount. We stated that the overall impact across all hospital groups is 
an increase of 0.1 percent, however the overall impact is actually a 
decrease of 0.1 percent. We also stated that ``the largest increase in 
payments due to this change is estimated to be 0.4 percent for teaching 
IPFs with more than 30 percent interns and residents to beds.'' This 
should be corrected to reflect that the largest decreases in payments 
are estimated to be 0.4 percent for urban government IPF units and 0.4 
percent for teaching IPFs with more than 30 percent interns and 
residents to beds.
    On page 42676, in the first column, in the first full paragraph, we 
incorrectly stated that ``The average estimated increase for all IPFs 
is approximately 2.1 percent based on the FY 2019 claims,'' and that 
this overall increase includes ``the overall estimated 0.1 percent 
increase in estimated IPF outlier payments as a percent of total 
payments from updating the outlier fixed dollar loss threshold 
amount.'' These statements should be corrected to reflect that the 
average estimated increase for all IPFs is approximately 1.9 percent, 
and that this includes the overall estimated 0.1 percent decrease in 
estimated IPF outlier payments as a percent of total payments from 
updating the outlier fixed dollar loss threshold amount.
    On page 42676, in the second column, in the first full paragraph, 
we incorrectly stated that ``IPF payments are therefore estimated to 
increase by 2.1 percent in urban areas and 2.2 percent in rural areas 
based on this finalized policy. Overall, IPFs are estimated to 
experience a net increase in payments as a result of the updates in 
this final rule. The largest payment increase is estimated at 2.7 
percent for IPFs in the South Atlantic region.'' It is still correct 
that IPFs are estimated to experience a net increase in payments as a 
result of the updated in this final rule, however these statements 
should be corrected to reflect that IPF payments are estimated to 
increase by 1.8 percent in urban areas and 2.1 percent in rural areas, 
and that the largest increases are estimated at 2.5 percent for IPFs in 
the South Atlantic region and 2.5 percent for rural, government-owned 
IPF hospitals.
    On page 42677, in the third column, in the first full paragraph, we 
incorrectly stated that the number of IPFs with data available in the 
PSF and with claims in our FY 2019 MedPAR claims dataset was 1,519. The 
correct number should be 1,520.
    On page 42677, Table 19 incorrectly states that the estimate of 
annualized monetized transfers from the federal government to IPF 
Medicare providers is $80 million. This table should be corrected to 
reflect that the estimate of annualized monetized transfers from the 
federal government to IPF Medicare providers is $70 million.
    On page 42677, under F. Regulatory Flexibility Act, in the third 
column, in line 10, we incorrectly stated that the number of IPFs in 
our database is 1,519. The correct number of IPFs in our database is 
1,520.

B. Summary of Errors and Corrections to the IPF PPS Addenda Posted on 
the CMS Website

    In Addendum A of the FY 2022 IPF PPS final rule, we have corrected 
the outlier fixed dollar loss threshold amount from $14,470 to $16,040 
on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientPsychFacilPPS/tools.

III. Waiver of Proposed Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a rule take effect in accordance with section 553(b) of 
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we 
can waive this notice and comment procedure if the Secretary finds, for 
good cause, that the notice and comment process is impracticable, 
unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and the reasons therefore in the rule.
    Section 553(d) of the APA ordinarily requires a 30-day delay in 
effective date of final rules after the date of their publication in 
the Federal Register. This 30-day delay in effective date can be 
waived, however, if an agency finds for good cause that the delay is 
impracticable, unnecessary, or contrary to the public interest, and the 
agency incorporates a statement of the findings and its reasons in the 
rule issued.
    We believe that this correcting document does not constitute a rule 
that would be subject to the notice and comment or delayed effective 
date requirements. This document corrects technical and typographic 
errors in the preamble of the FY 2022 IPF PPS final rule, but does not 
make substantive

[[Page 54633]]

changes to the policies or payment methodologies that were adopted in 
the final rule. As a result, this correcting document is intended to 
ensure that the information in the FY 2022 IPF PPS final rule 
accurately reflects the policies adopted in that document.
    In addition, even if this were a rule to which the notice and 
comment procedures and delayed effective date requirements applied, we 
find that there is good cause to waive such requirements. Undertaking 
further notice and comment procedures to incorporate the corrections in 
this document into the final rule or delaying the effective date would 
be contrary to the public interest because it is in the public's 
interest for IPFs to receive appropriate payments in as timely a manner 
as possible, and to ensure that the FY 2022 IPF PPS final rule 
accurately reflects our policies as of the date they take effect and 
are applicable. Furthermore, such procedures would be unnecessary, as 
we are not altering our payment methodologies or policies, but rather, 
we are simply correctly implementing the policies that we previously 
proposed, received comment on, and subsequently finalized. This 
correcting document is intended solely to ensure that the FY 2022 IPF 
PPS final rule accurately reflects these payment methodologies and 
policies. For these reasons, we believe we have good cause to waive the 
notice and comment and effective date requirements. Moreover, even if 
these corrections were considered to be retroactive rulemaking, they 
would be authorized under section 1871(e)(1)(A)(ii) of the Act, which 
permits the Secretary to issue a rule for the Medicare program with 
retroactive effect if the failure to do so would be contrary to the 
public interest. As we have explained previously, we believe it would 
be contrary to the public interest not to implement the corrections in 
this correcting document because it is in the public's interest for 
IPFs to receive appropriate payments in as timely a manner as possible, 
and to ensure that the FY 2022 IPF PPS final rule accurately reflects 
our policies.

IV. Correction of Errors

    In FR Doc. 2021-16336 of August 4, 2021 (86 FR 42608), make the 
following corrections:
    1. On page 42608, in the third column, second bullet, seventh sub-
bullet, in line 2, remove the number ``$14,470'' and add in its place 
``$16,040''.
    2. On page 42609, in first row of the table, in the right column, 
remove ``$80 million'' and add in its place ``$70 million''.
    3. On page 42623, in the third column, in the third full paragraph,
    a. In line 21, remove ``$1.9 percent'' and add in its place ``2.1 
percent''.
    b. In line 23, remove the number ``$14,470'' and add in its place 
``$16,040''.
    4. On page 42623, in the third column, in the third full paragraph, 
in line 27, remove the word ``decrease'' and add in its place 
``increase''.
    5. On page 42634, in the second column; in line 3 from the bottom 
of the page, in footnote 93, remove the words ``Accessed on 7/6/2021'' 
and add in their place ``Accessed on 7/16/2021''.
    6. On page 42645, in the second column; in the first full 
paragraph, in line 6 and 7, remove the words ``is this measure's 
objective'' and add in their place ``is not this measure's primary 
objective''.
    7. On page 42647, in the second column; in footnote 154, revise the 
citation to read as follows, ``Nemani et al., Association of 
Psychiatric Disorders With Mortality Among Patients With COVID-19, JAMA 
Psychiatry. 2021;78(4):380-386. doi:10.1001/jamapsychiatry.2020.4442; 
COVID-19 and people at increased risk, CDC, https://www.cdc.gov/drugoverdose/resources/covid-drugs-QA.html; U. Saengow et al., Alcohol: 
A probable risk factor of COVID-19 severity, 7-20-2021. doi:10.1111/
add.15194''.
    8. On page 42649, in the third column; the first full paragraph, 
the 20th line from the top of the page, remove the words ``a 
comprehensive program to address topped out'' and add in their place 
``a comprehensive program to address tobacco use''.
    9. On page 42657, in the second column; the last paragraph under 
``b. Updated Reference to QualityNet Administrator in the Code of 
Federal Regulations'', the 32nd line from the top of the page, remove 
the words ``We are finalizing our proposal to no longer require 
facilities to replace the term `QualityNet system administrator' with 
``QualityNet security official' at Sec.  412.434(b)(3) as proposed'' 
and add in their place ``We are finalizing our proposal to replace the 
term `QualityNet system administrator' with ``QualityNet security 
official' at Sec.  412.434(b)(3) as proposed.''
    10. On page 42659, revise Table 7 to read as follows:

            Table 7--Patient-Level Data Submission Requirements for CY 2014 IPFQR Program Measure Set
----------------------------------------------------------------------------------------------------------------
            NQF No.                  Measure ID              Measure            Patient-level data  submission
----------------------------------------------------------------------------------------------------------------
0640...........................  HBIPS-2...........  Hours of Physical       Yes, numerator only.
                                                      Restraint Use.
0641...........................  HBIPS-3...........  Hours of Seclusion Use  Yes, numerator only.
0560...........................  HBIPS-5...........  Patients Discharged on  Yes.
                                                      Multiple
                                                      Antipsychotic
                                                      Medications with
                                                      Appropriate
                                                      Justification.
0576...........................  FUH...............  Follow-Up After         No (claims-based).
                                                      Hospitalization for
                                                      Mental Illness.
N/A *..........................  SUB-2 and SUB-2a..  Alcohol Use Brief       Yes.
                                                      Intervention Provided
                                                      or Offered and SUB-2a
                                                      Alcohol Use Brief
                                                      Intervention.
N/A *..........................  SUB-3 and SUB-3a..  Alcohol and Other Drug  Yes.
                                                      Use Disorder
                                                      Treatment Provided or
                                                      Offered at Discharge
                                                      and SUB-3a Alcohol
                                                      and Other Drug Use
                                                      Disorder Treatment at
                                                      Discharge.
N/A *..........................  TOB-2 and TOB-2a..  Tobacco Use Treatment   Yes.
                                                      Provided or Offered
                                                      and TOB-2a Tobacco
                                                      Use Treatment.
N/A *..........................  TOB-3 and TOB-3a..  Tobacco Use Treatment   Yes.
                                                      Provided or Offered
                                                      at Discharge and TOB-
                                                      3a Tobacco Use
                                                      Treatment at
                                                      Discharge.
1659...........................  IMM-2.............  Influenza Immunization  Yes.
N/A *..........................  N/A...............  Transition Record with  Yes.
                                                      Specified Elements
                                                      Received by
                                                      Discharged Patients
                                                      (Discharges from an
                                                      Inpatient Facility to
                                                      Home/Self Care or Any
                                                      Other Site of Care).
N/A............................  N/A...............  Screening for           Yes.
                                                      Metabolic Disorders.
2860...........................  N/A...............  Thirty-Day All-Cause    No (claims-based).
                                                      Unplanned Readmission
                                                      Following Psychiatric
                                                      Hospitalization in an
                                                      Inpatient Psychiatric
                                                      Facility.

[[Page 54634]]

 
3205...........................  Med Cont..........  Medication              No (claims-based).
                                                      Continuation
                                                      Following Inpatient
                                                      Psychiatric Discharge.
TBD............................  COVID HCP.........  COVID-19 Healthcare     No (calculated for HCP).
                                                      Personnel (HCP)
                                                      Vaccination Measure.
----------------------------------------------------------------------------------------------------------------
* Measure is no longer endorsed by the NQF but was endorsed at time of adoption. Section 1886(s)(4)(D)(ii) of
  the Act authorizes the Secretary to specify a measure that is not endorsed by the NQF as long as due
  consideration is given to measures that have been endorsed or adopted by a consensus organization identified
  by the Secretary. We attempted to find available measures for each of these clinical topics that have been
  endorsed or adopted by a consensus organization and found no other feasible and practical measures on the
  topics for the IPF setting.

    11. On page 42661, in the third column; in the last paragraph under 
V. Collection of Information Requirements, the 8th line from the bottom 
of the page, remove the sentence ``We have not made any changes from 
what was proposed'' and add in its place ``We have updated these 
estimates based on the proposals finalized in this final rule''.
    12. On page 42669, revise Table 15 to read as follows.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                  Annual time
                                                                 Estimated      Time per case         per      Number IPFs     Total       Total annual
    NQF No.           Measure ID         Measure description     cases (per        (hours)          facility        **      annual time      cost ($)
                                                                 facility)                          (hours)                   (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
0576...........  FUH................  Follow-Up After                     0  0..................            0        1,634            0                0
                                       Hospitalization for
                                       Mental Illness *.
0648...........  N/A................  Timely Transmission of          (609)  0.25...............       152.25        1,634  (248,776.5)  (10,199,836.50)
                                       Transition Record
                                       (Discharges from an
                                       Inpatient Facility to
                                       Home/Self Care or Any
                                       Other Site of Care).
                                                               -----------------------------------------------------------------------------------------
    Total......  ...................  ........................        (609)  Varies.............       152.25        1,634  (248,776.5)  (10,199,836.50)
--------------------------------------------------------------------------------------------------------------------------------------------------------
* CMS will collect these data using Medicare Part A and Part B claims; therefore, these measures will not require facilities to submit data on any
  cases.
** We note that the previously approved number of IPFs is 1,679; however, we adjusted that in Table 12 based on updated data.
*** At $41.00/hr.

    13. On page 42672, below Table 15, in the second column, in the 
second full paragraph, remove the paragraph,
    ``We estimate that the total impact of these changes for FY 2022 
payments compared to FY 2021 payments will be a net increase of 
approximately $80 million. This reflects an $75 million increase from 
the update to the payment rates (+$100 million from the 2nd quarter 
2021 IGI forecast of the 2016-based IPF market basket of 2.7 percent, 
and -$25 million for the productivity adjustment of 0.7 percentage 
point), as well as a $5 million increase as a result of the update to 
the outlier threshold amount. Outlier payments are estimated to change 
from 1.9 percent in FY 2021 to 2.0 percent of total estimated IPF 
payments in FY 2022.''

and add in its place

    ``We estimate that the total impact of these changes for FY 2022 
payments compared to FY 2021 payments will be a net increase of 
approximately $70 million. This reflects a $75 million increase from 
the update to the payment rates (+$100 million from the 2nd quarter 
2021 IGI forecast of the 2016-based IPF market basket of 2.7 percent, 
and -$25 million for the productivity adjustment of 0.7 percentage 
point), as well as a $5 million decrease as a result of the update to 
the outlier threshold amount. Outlier payments are estimated to change 
from 2.1 percent in FY 2021 to 2.0 percent of total estimated IPF 
payments in FY 2022.''
    14. On page 42672 in the third column, in the fourth full 
paragraph,
    a. In line 2, remove ``$80 million'' and add in its place ``$70 
million''.
    b. In line 6, remove the word ``increase'' and add in its place 
``decrease''.
    15. On pages 42674 and 42675, revise Table 18 to read as follows:

                                                     Table 18--FY 2022 IPF PPS Final Payment Impacts
                                                         [Percent change in columns 3 through 5]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                        Number of             Outlier          FY 2022 wage index,      Total percent
                                                                       facilities      ----------------------     LRS, and COLA          change \1\
                        Facility by type                         ----------------------                      -------------------------------------------
                                                                   FY 2019    FY 2020    FY 2019    FY 2020    FY 2019    FY 2020    FY 2019    FY 2020
                                                                    claims     claims     claims     claims     claims     claims     claims     claims
--------------------------------------------------------------------------------------------------------------------------------------------------------
                               (1)                                         (2)
                                                                           (3)
                                                                           (4)
                                                                           (5)
--------------------------------------------------------------------------------------------------------------------------------------------------------
All Facilities..................................................      1,520      1,534       -0.1       -1.1        0.0        0.0        1.9        0.9
Total Urban.....................................................      1,221      1,235       -0.1       -1.1        0.0        0.0        1.8        0.8
    Urban unit..................................................        740        737       -0.2       -1.8       -0.1       -0.1        1.7        0.1
    Urban hospital..............................................        481        498        0.0       -0.3        0.0        0.0        2.0        1.7
Total Rural.....................................................        299        299       -0.1       -0.7        0.2        0.2        2.1        1.5
    Rural unit..................................................        239        238       -0.1       -0.8        0.1        0.1        2.0        1.3
    Rural hospital..............................................         60         61       -0.1       -0.4        0.4        0.4        2.3        2.0
By Type of Ownership:
    Freestanding IPFs:
        Urban Psychiatric Hospitals:
            Government..........................................        116        123       -0.2       -1.7       -0.2       -0.2        1.6        0.1

[[Page 54635]]

 
            Non-Profit..........................................         95         97       -0.1       -0.5       -0.2       -0.1        1.8        1.4
            For-Profit..........................................        270        278        0.0       -0.1        0.1        0.1        2.1        2.0
        Rural Psychiatric Hospitals:
            Government..........................................         31         32       -0.1       -0.8        0.5        0.6        2.5        1.8
            Non-Profit..........................................         12         12       -0.1       -1.2       -0.1        0.0        1.8        0.7
            For-Profit..........................................         17         17        0.0        0.0        0.4        0.4        2.4        2.4
    IPF Units:
        Urban:
            Government..........................................        108        107       -0.4       -3.4        0.1        0.1        1.8       -1.4
            Non-Profit..........................................        480        478       -0.2       -1.7       -0.1       -0.1        1.7        0.2
            For-Profit..........................................        152        152       -0.1       -0.7       -0.1       -0.1        1.8        1.2
        Rural:
            Government..........................................         58         57        0.0       -0.4        0.4        0.3        2.3        1.9
            Non-Profit..........................................        132        131       -0.1       -1.0        0.1        0.1        1.9        1.0
            For-Profit..........................................         49         50       -0.1       -0.6       -0.2       -0.2        1.7        1.2
By Teaching Status:
    Non-teaching................................................      1,322      1,336       -0.1       -0.8        0.0        0.0        1.9        1.1
    Less than 10% interns and residents to beds.................        109        109       -0.2       -1.9        0.1        0.1        1.9        0.2
    10% to 30% interns and residents to beds....................         67         67       -0.3       -2.4       -0.1       -0.1        1.6       -0.5
    More than 30% interns and residents to beds.................         22         22       -0.4       -3.2       -0.1       -0.1        1.5       -1.3
By Region:
    New England.................................................        106        106       -0.2       -1.2       -0.4       -0.4        1.5        0.3
    Mid-Atlantic................................................        215        216       -0.2       -2.0       -0.2       -0.2        1.6       -0.2
    South Atlantic..............................................        240        243       -0.1       -0.7        0.6        0.6        2.5        1.9
    East North Central..........................................        243        244       -0.1       -0.7       -0.2       -0.2        1.7        1.0
    East South Central..........................................        152        155       -0.1       -0.7       -0.5       -0.5        1.4        0.7
    West North Central..........................................        108        109       -0.2       -1.4        0.1        0.1        2.0        0.7
    West South Central..........................................        224        227       -0.1       -0.5       -0.3       -0.3        1.7        1.3
    Mountain....................................................        103        103       -0.1       -0.7        0.2        0.3        2.2        1.6
    Pacific.....................................................        129        131       -0.2       -1.4        0.4        0.4        2.3        1.0
By Bed Size:
    Psychiatric Hospitals:
        Beds: 0-24..............................................         83         88       -0.1       -0.5        0.1        0.0        2.0        1.5
        Beds: 25-49.............................................         79         83        0.0       -0.2       -0.3       -0.3        1.7        1.5
        Beds: 50-75.............................................         84         88        0.0       -0.1        0.1        0.2        2.1        2.2
        Beds: 76 +..............................................        295        300        0.0       -0.4        0.1        0.1        2.1        1.7
    Psychiatric Units:
        Beds: 0-24..............................................        536        531       -0.2       -1.2        0.0        0.0        1.8        0.7
        Beds: 25-49.............................................        259        259       -0.2       -1.3        0.0        0.0        1.9        0.7
        Beds: 50-75.............................................        114        114       -0.2       -2.0       -0.3       -0.3        1.5       -0.3
        Beds: 76 +..............................................         70         71       -0.3       -2.5        0.0        0.0        1.8       -0.5
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ This column includes the impact of the updates in columns (3) and (4) above, and of the final IPF market basket increase factor for FY 2022 (2.7
  percent), reduced by 0.7 percentage point for the productivity adjustment as required by section 1886(s)(2)(A)(i) of the Act. Note, the products of
  these impacts may be different from the percentage changes shown here due to rounding effects.

    16. On page 42675 in the first column, in the second full 
paragraph,
    a. In line 2, remove the number ``1,519'' and add in its place 
``1,520''.
    b. In line 6, remove ``1.9 percent'' and add in its place ``2.1 
percent''.
    17. On page 42675, in the second column,
    a. In the first full paragraph,
    (1) In line 5, remove the sentence,
    ``Based on the FY 2019 claims, the estimated change in total IPF 
payments for FY 2022 would include an approximate 0.1 percent increase 
in payments because we would expect the outlier portion of total 
payments to increase from approximately 1.9 percent to 2.0 percent.''

and add in its place,

    ``Based on the FY 2019 claims, the estimated change in total IPF 
payments for FY 2022 would include an approximate 0.1 percent decrease 
in payments because we would expect the outlier portion of total 
payments to decrease from approximately 2.1 percent to 2.0 percent.''
    (2) In the second full paragraph and continuing into the first 
paragraph of the third column, remove the paragraph,

    ``The overall impact of the estimated increase or decrease to 
payments due to updating the outlier fixed dollar loss threshold (as 
shown in column 3 of Table 18), across all hospital groups, is 0.1 
percent based on the FY 2019 claims, or -1.1 percent based on the FY 
2020 claims. Based on the FY 2019 claims, the largest increase in 
payments due to this change is estimated to be 0.4 percent for 
teaching IPFs with more than 30 percent interns and residents to 
beds. Among teaching IPFs, this same provider facility type would 
experience the largest estimated decrease in payments if we were to 
instead increase the outlier fixed dollar loss threshold based on 
the FY 2020 claims distribution.''

and add in its place

    ``The overall impact of the estimated decrease to payments due 
to updating the outlier fixed dollar loss threshold (as shown in 
column 3 of Table 18), across all hospital groups, is a 0.1 percent 
decrease based on the FY 2019 claims, or a 1.1 percent decrease 
based on the FY 2020 claims. Based on the FY 2019 claims, the 
largest decreases in payments due to this change are estimated to be 
0.4 percent for urban government IPF units and 0.4 percent for 
teaching IPFs with more than 30 percent interns and residents to 
beds. These same provider facility types would also experience the 
largest estimated decreases in payments if we were to instead 
increase the outlier fixed dollar loss threshold based on the FY 
2020 claims distribution.''

    18. On page 42676,
    a. In the first column, in the first full paragraph, remove the 
paragraph,

    ``Finally, column 5 compares the total final changes reflected 
in this final rule for FY 2022 to the estimates for FY 2021 (without 
these changes). The average estimated

[[Page 54636]]

increase for all IPFs is approximately 2.1 percent based on the FY 
2019 claims, or 0.9 percent based on the FY 2020 claims. These 
estimated net increases include the effects of the 2016-based market 
basket update of 2.7 percent reduced by the productivity adjustment 
of 0.7 percentage point, as required by section 1886(s)(2)(A)(i) of 
the Act. They also include the overall estimated 0.1 percent 
increase in estimated IPF outlier payments as a percent of total 
payments from updating the outlier fixed dollar loss threshold 
amount. In addition, column 5 includes the distributional effects of 
the final updates to the IPF wage index, the labor-related share, 
and the final updated COLA factors, whose impacts are displayed in 
column 4. Based on the FY 2020 claims distribution, the increase to 
estimated payments due to the market basket update factor are offset 
in large part for some provider types by the increase to the outlier 
fixed dollar loss threshold.''

and add in its place

    ``Finally, column 5 compares the total final changes reflected 
in this final rule for FY 2022 to the estimates for FY 2021 (without 
these changes). The average estimated increase for all IPFs is 
approximately 1.9 percent based on the FY 2019 claims, or 0.9 
percent based on the FY 2020 claims. These estimated net increases 
include the effects of the 2016-based IPF market basket update of 
2.7 percent reduced by the productivity adjustment of 0.7 percentage 
point, as required by section 1886(s)(2)(A)(i) of the Act. They also 
include the overall estimated 0.1 percent decrease in estimated IPF 
outlier payments as a percent of total payments from updating the 
outlier fixed dollar loss threshold amount. In addition, column 5 
includes the distributional effects of the final updates to the IPF 
wage index, the labor-related share, and the final updated COLA 
factors, whose impacts are displayed in column 4. Based on the FY 
2020 claims distribution, the increase to estimated payments due to 
the market basket update factor are offset in large part for some 
provider types by the increase to the outlier fixed dollar loss 
threshold.''

    b. In the second column, in the first full paragraph, remove the 
paragraph,

    ``IPF payments are therefore estimated to increase by 2.1 
percent in urban areas and 2.2 percent in rural areas based on this 
finalized policy. Overall, IPFs are estimated to experience a net 
increase in payments as a result of the updates in this final rule. 
The largest payment increase is estimated at 2.7 percent for IPFs in 
the South Atlantic region.''

and add in its place

    ``IPF payments are therefore estimated to increase by 1.8 
percent in urban areas and 2.1 percent in rural areas based on this 
finalized policy. Overall, IPFs are estimated to experience a net 
increase in payments as a result of the updates in this final rule. 
The largest payment increases are estimated at 2.5 percent for IPFs 
in the South Atlantic region and 2.5 percent for rural, government-
owned IPF hospitals.''

    19. On page 42677,
    a. Above Table 15, in the third column, in the first full 
paragraph, in line 13, remove the number ``1,519'' and add in its place 
``1,520''.
    b. Revise Table 19 to read as follows:

                                Table 19--Accounting Statement: Classification of Estimated Costs, Savings, and Transfers
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                            Primary                                                                   Units
                                           estimate                                    -----------------------------------------------------------------
               Category                   ($million/     Low estimate    High estimate                   Discount rate
                                             year)                                       Year dollars         (%)                Period covered
--------------------------------------------------------------------------------------------------------------------------------------------------------
Regulatory Review Costs...............             0.2  ..............  ..............            2020  ..............  FY 2022.
Annualized Monetized Costs Savings....           -0.51           -0.38           -0.64            2019               7  FY 2023-FY 2031.
                                                 -0.44           -0.33           -0.54            2019               3  FY 2023-FY 2031.
Annualized Monetized Transfers from                 70  ..............  ..............         FY 2022  ..............  FY 2022.
 Federal Government to IPF Medicare
 Providers.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    c. Below Table 19, in the third column, in line 10, remove the 
number ``1,519'' and add in its place ``1,520''.

Karuna Seshasai,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2021-21546 Filed 9-30-21; 4:15 pm]
BILLING CODE 4120-01-P