[Federal Register Volume 86, Number 200 (Wednesday, October 20, 2021)]
[Rules and Regulations]
[Pages 58019-58039]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-22724]



[[Page 58019]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 413, 425, 455, and 495

[CMS-1752-F2 and CMS-1762-F2]
RIN 0938-AU44 and 0938-AU56


Medicare Program; Hospital Inpatient Prospective Payment Systems 
for Acute Care Hospitals and the Long-Term Care Hospital Prospective 
Payment System and Policy Changes and Fiscal Year 2022 Rates; Quality 
Programs and Medicare Promoting Interoperability Program Requirements 
for Eligible Hospitals and Critical Access Hospitals; Changes to 
Medicaid Provider Enrollment; and Changes to the Medicare Shared 
Savings Program; Corrections

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Final rule; correction and correcting amendment.

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SUMMARY: This document corrects technical and typographical errors in 
the final rule that appeared in the August 13, 2021, issue of the 
Federal Register titled ``Medicare Program; Hospital Inpatient 
Prospective Payment Systems for Acute Care Hospitals and the Long Term 
Care Hospital Prospective Payment System and Policy Changes and Fiscal 
Year 2022 Rates; Quality Programs and Medicare Promoting 
Interoperability Program Requirements for Eligible Hospitals and 
Critical Access Hospitals; Changes to Medicaid Provider Enrollment; and 
Changes to the Medicare Shared Savings Program.''

DATES: 
    Effective date: The final rule corrections and correcting amendment 
are effective on October 19, 2021.
    Applicability date: The final rule corrections and correcting 
amendment are applicable to discharges occurring on or after October 1, 
2021.

FOR FURTHER INFORMATION CONTACT: Donald Thompson, (410) 786-4487, and 
Michele Hudson, (410) 786-4487, Operating Prospective Payment, Wage 
Index, Hospital Geographic Reclassifications, Medicare Disproportionate 
Share Hospital (DSH) Payment Adjustment, Graduate Medical Education, 
and Critical Access Hospital (CAH) Issues. Mady Hue, (410) 786-4510, 
and Andrea Hazeley, (410) 786-3543, MS-DRG Classification Issues.
    Allison Pompey, (410) 786-2348, New Technology Add-On Payments 
Issues. Julia Venanzi, [email protected], Hospital Inpatient 
Quality Reporting and Hospital Value-Based Purchasing Programs.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2021-16519 of August 13, 2021 (86 FR 44774), there were 
a number of technical and typographical errors that are identified and 
corrected in this final rule correction and correcting amendment. The 
final rule corrections and correcting amendment are applicable to 
discharges occurring on or after October 1, 2021, as if they had been 
included in the document that appeared in the August 13, 2021, Federal 
Register.

II. Summary of Errors

A. Summary of Errors in the Preamble

    On page 44878, we are correcting an inadvertent error in the 
reference to the number of technologies for which we proposed to allow 
a one-time extension of new technology add-on payments for fiscal year 
(FY) 2022.
    On page 44889, we are correcting an inadvertent typographical error 
in the International Classification of Disease, 10th Revision, 
Procedure Coding System (ICD-10-PCS) procedure code describing the 
percutaneous endoscopic repair of the esophagus.
    On page 44960, in the table displaying the Medicare-Severity 
Diagnosis Related Groups (MS-DRGs) subject to the policy for replaced 
devices offered without cost or with a credit for FY 2022, we are 
correcting inadvertent typographical errors in the MS-DRGs describing 
Hip Replacement with Principal Diagnosis of Hip Fracture with and 
without MCC, respectively.
    On pages 45047, 45048, and 45049, in our discussion of the new 
technology add-on payments for FY 2022, we are correcting typographical 
and technical errors in referencing sections of the final rule.
    On page 45133, we are correcting an error in the maximum new 
technology add-on payment for a case involving the use of 
AprevoTM Intervertebral Body Fusion Device.
    On page 45150, we inadvertently omitted ICD-10-CM codes from the 
list of diagnosis codes used to identify cases involving the use of the 
INTERCEPT Fibrinogen Complex that would be eligible for new technology 
add-on payments.
    On page 45157, we inadvertently omitted the ICD-10-CM diagnosis 
codes used to identify cases involving the use of FETROJA[supreg] for 
HABP/VABP.
    On page 45158, we inadvertently omitted the ICD-10-CM diagnosis 
codes used to identify cases involving the use of 
RECARBRIOTM for HABP/VABP.
    On pages 45291, 45293, and 45294, in three tables that display 
previously established, newly updated, and estimated performance 
standards for measures included in the Hospital Value-Based Purchasing 
Program, we are correcting errors in the numerical values for all 
measures in the Clinical Outcomes Domain that appear in the three 
tables.
    On page 45312, in our discussion of payments for indirect and 
direct graduate medical education costs and Intern and Resident 
Information System (IRIS) data, we made a typographical error in our 
response to a comment.
    On page 45386, we made an inadvertent typographical error in our 
discussion of the Hospital Inpatient Quality Reporting (IQR) Program 
Severe Hyperglycemia electronic clinical quality measure (eCQM).
    On page 45400, in our discussion of the Hospital Inpatient Quality 
Reporting (IQR) Program measures for fiscal year (FY) 2024, we 
mislabeled the table title and inadvertently included a measure not 
pertaining to the FY 2024 payment determination along with its 
corresponding footnote.
    On page 45404, in our discussion the Hospital Inpatient Quality 
Reporting (IQR) Program, we included a table with the measures for the 
FY 2025 payment determination. In the notes that immediately followed 
the table, we made a typographical error in the date associated with 
the voluntary reporting period for the Hybrid Hospital-Wide All-Cause 
Risk Standardized Mortality (HWM) measure.

B. Summary of Errors in the Regulations Text

    On page 45521, in the regulations text for Sec.  413.24(f)(5)(i) 
introductory text and (f)(5)(i)(A) regarding cost reporting forms and 
teaching hospitals, we inadvertently omitted revisions that were 
discussed in the preamble.

C. Summary of Errors in the Addendum

    In the FY 2022 Hospital Inpatient Prospective Payment Systems and 
Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) 
final rule (85 FR 45166), we stated that we excluded the wage data for 
critical access hospitals (CAHs) as discussed in the FY 2004 IPPS final 
rule (68 FR 45397 through 45398); that is, any hospital that is 
designated as a CAH by 7 days prior to the publication of the 
preliminary wage index public use file (PUF) is excluded from the 
calculation

[[Page 58020]]

of the wage index. We inadvertently excluded a hospital that converted 
to CAH status after January 24, 2021, the cut-off date for CAH 
exclusion from the FY 2022 wage index. (CMS Certification Number (CCN) 
230118) Therefore, we restored the wage data for this hospital and 
included it in our calculation of the wage index. This correction 
necessitated the recalculation of the FY 2022 wage index for rural 
Michigan (rural state code 23), as reflected in Table 3, and affected 
the final FY 2022 wage index for rural Michigan 23 as well as the rural 
floor for the State of Michigan. As discussed in this section, the 
final FY 2022 IPPS wage index is used when determining total payments 
for purposes of all budget neutrality factors (except for the MS-DRG 
reclassification and recalibration budget neutrality factor) and the 
final outlier threshold.
    We note, in the final rule, we correctly listed the number of 
hospitals with CAH status removed from the FY 2022 wage index (86 FR 
45166), the number of hospitals used for the FY 2022 wage index (86 FR 
45166) and the number of hospital occupational mix surveys used for the 
FY 2022 wage index (86 FR 45173). Additionally, the FY 2022 national 
average hourly wage (unadjusted for occupational mix) (86 FR 45172), 
the FY 2022 occupational mix adjusted national average hourly wage (86 
FR 45173), and the FY 2022 national average hourly wages for the 
occupational mix nursing subcategories (86 FR 45174) listed in the 
final rule remain unchanged. Because the numbers and values noted 
previously are correctly stated in the preamble of the final rule and 
remain unchanged, we do not include any corrections in section IV.A. of 
this final rule correction and correcting amendment.
    We made an inadvertent error in the Medicare Geographic 
Classification Review Board (MGCRB) reclassification status of one 
hospital in the FY 2022 IPPS/LTCH PPS final rule. Specifically, CCN 
360259 is incorrectly listed in Table 2 as reclassified to CBSA 19124. 
The correct reclassification area is to its geographic ``home'' of CBSA 
45780. This correction necessitated the recalculation of the FY 2022 
wage index for CBSA 19124 and affected the final FY 2022 wage index 
with reclassification. The final FY 2022 IPPS wage index with 
reclassification is used when determining total payments for purposes 
of all budget neutrality factors (except for the MS-DRG 
reclassification and recalibration budget neutrality factor and the 
wage index budget neutrality adjustment factor) and the final outlier 
threshold.
    As discussed further in section II.E. of this final rule correction 
and correcting amendment, we made updates to the calculation of Factor 
3 of the uncompensated care payment methodology to reflect updated 
information on hospital mergers received in response to the final rule 
and made corrections for report upload errors. Factor 3 determines the 
total amount of the uncompensated care payment a hospital is eligible 
to receive for a fiscal year. This hospital-specific payment amount is 
then used to calculate the amount of the interim uncompensated care 
payments a hospital receives per discharge. Per discharge uncompensated 
care payments are included when determining total payments for purposes 
of all of the budget neutrality factors and the final outlier 
threshold. As a result, the revisions made to the calculation of Factor 
3 to address additional merger information and report upload errors 
directly affected the calculation of total payments and required the 
recalculation of all the budget neutrality factors and the final 
outlier threshold.
    Due to the correction of the combination of errors that are 
discussed previously (correcting the number of hospitals with CAH 
status, the correction to the MGCRB reclassification status of one 
hospital, and the revisions to Factor 3 of the uncompensated care 
payment methodology), we recalculated all IPPS budget neutrality 
adjustment factors, the fixed-loss cost threshold, the final wage 
indexes (and geographic adjustment factors (GAFs)), the national 
operating standardized amounts and capital Federal rate. We note that 
the fixed-loss cost threshold was unchanged after these recalculations. 
Therefore, we made conforming changes to the following:
     On page 45532, the table titled ``Summary of FY 2022 
Budget Neutrality Factors''.
     On page 45537, the estimated total Federal capital 
payments and the estimated capital outlier payments.
     On pages 45542 and 45543, the calculation of the outlier 
fixed-loss cost threshold, total operating Federal payments, total 
operating outlier payments, the outlier adjustment to the capital 
Federal rate and the related discussion of the percentage estimates of 
operating and capital outlier payments.
     On page 45545, the table titled ``Changes from FY 2021 
Standardized Amounts to the FY 2022 Standardized Amounts''.
    On pages 45553 through 45554, in our discussion of the 
determination of the Federal hospital inpatient capital related 
prospective payment rate update, due to the recalculation of the GAFs, 
we have made conforming corrections to the capital Federal rate. As a 
result of these changes, we also made conforming corrections in the 
table showing the comparison of factors and adjustments for the FY 2021 
capital Federal rate and FY 2022 capital Federal rate. As we noted in 
the final rule, the capital Federal rate is calculated using unrounded 
budget neutrality and outlier adjustment factors. The unrounded GAF/DRG 
budget neutrality factor, the unrounded Quartile/Cap budget neutrality 
factor, and the unrounded outlier adjustment to the capital Federal 
rate were revised because of these errors. However, after rounding 
these factors to 4 decimal places as displayed in the final rule, the 
rounded factors were unchanged from the final rule.
    On pages 45570 and 45571, we are making conforming corrections to 
the national adjusted operating standardized amounts and capital 
standard Federal payment rate (which also include the rates payable to 
hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a 
result of the conforming corrections to certain budget neutrality 
factors, as previously described.

D. Summary of Errors in the Appendices

    On pages 45576 through 45580, 45582 through 45583, and 45598 
through 45600, in our regulatory impact analyses, we have made 
conforming corrections to the factors, values, and tables and 
accompanying discussion of the changes in operating and capital IPPS 
payments for FY 2022 and the effects of certain IPPS budget neutrality 
factors as a result of the technical errors that lead to changes in our 
calculation of the operating and capital IPPS budget neutrality 
factors, outlier threshold, final wage indexes, operating standardized 
amounts, and capital Federal rate (as described in section II.C. of 
this final rule correction and correcting amendment). These conforming 
corrections include changes to the following:
     On pages 45576 through 45578, the table titled ``Table I--
Impact Analysis of Changes to the IPPS for Operating Costs for FY 
2022''.
     On pages 45582 and 45583, the table titled ``Table II--
Impact Analysis of Changes for FY 2022 Acute Care Hospital Operating 
Prospective Payment System (Payments per discharge)''.
     On pages 45599 and 45600, the table titled ``Table III--
Comparison of

[[Page 58021]]

Total Payments per Case [FY 2021 Payments Compared to FY 2022 
Payments]''.
    On pages 45584 and 45585 we are correcting the maximum new-
technology add-on payment for a case involving the use of Fetroja, 
Recarbrio, Tecartus, and Abecma and related information in the untitled 
tables as well as making conforming corrections to the total estimated 
FY 2022 payments in the accompanying discussion of applications 
approved or conditionally approved for new technology add-on payments.
    On pages 45587 through 45589, we are correcting the discussion of 
the ``Effects of the Changes to Medicare DSH and Uncompensated Care 
Payments for FY 2022'' for purposes of the Regulatory Impact Analysis 
in Appendix A of the FY 2022 IPPS/LTCH PPS final rule, including the 
table titled ``Modeled Uncompensated Care Payments for Estimated FY 
2022 DSHs by Hospital Type: Uncompensated Care Payments ($ in 
Millions)*--from FY 2021 to FY 2022'', in light of the corrections 
discussed in section II.E. of this final rule correction and correcting 
amendment.
    On pages 45610 and 45611, we are making conforming corrections to 
the estimated expenditures under the IPPS as a result of the 
corrections to the maximum new technology add-on payment for a case 
involving the use of AprevoTM Intervertebral Body Fusion 
Device, Fetroja, Recarbrio, Abecma, and Tecartus as described in this 
section and in section II.A. of this final rule correction and 
correcting amendment.

E. Summary of Errors in and Corrections to Files and Tables Posted on 
the CMS Website

    We are correcting the errors in the following IPPS tables that are 
listed on pages 45569 and 45570 of the FY 2022 IPPS/LTCH PPS final rule 
and are available on the internet on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html. The tables that are available on the 
internet have been updated to reflect the revisions discussed in this 
final rule correction and correcting amendment.
    Table 2--Case-Mix Index and Wage Index Table by CCN-FY 2022 Final 
Rule. As discussed in section II.C. of this final rule correction and 
correcting amendment, we inadvertently excluded a hospital that 
converted to CAH status after January 24, 2021, the cut-off date for 
CAH exclusion from the FY 2022 wage index. (CMS Certification Number 
(CCN) 230118). Therefore, we restored provider 230118 to the table. 
Also, as discussed in section II.C. of this final rule correction and 
correcting amendment, CCN 360259 is incorrectly listed as reclassified 
to CBSA 19124. The correct reclassification area is to its geographic 
``home'' of CBSA 45780. In this table, we are correcting the columns 
titled ``Wage Index Payment CBSA'' and ``MGCRB Reclass'' to accurately 
reflect its reclassification to CBSA 45780. This correction 
necessitated the recalculation of the FY 2022 wage index for CBSA 
19124. As also discussed later in this section, because the wage 
indexes are one of the inputs used to determine the out-migration 
adjustment, some of the out-migration adjustments changed. Therefore, 
we are making corresponding changes to the affected values.
    Table 3.--Wage Index Table by CBSA--FY 2022 Final Rule. As 
discussed in section II.C. of this final rule correction and correcting 
amendment, we inadvertently excluded a hospital that converted to CAH 
status after January 24, 2021, the cut-off date for CAH exclusion from 
the FY 2022 wage index. (CMS Certification Number (CCN) 230118). 
Therefore, we recalculated the wage index for rural Michigan (rural 
state code 23), as reflected in Table 3, as well as the rural floor for 
the State of Michigan. Also, as discussed in section II.C. of this 
final rule correction and correcting amendment, CCN 360259 is 
incorrectly listed as reclassified to CBSA 19124. The correct 
reclassification area is to its geographic ``home'' of CBSA 45780. In 
this table, we are correcting the values that changed as a result of 
these corrections as well as any corresponding changes.
    Table 4A.--List of Counties Eligible for the Out-Migration 
Adjustment under Section 1886(d)(13) of the Act--FY 2022 Final Rule. As 
discussed in section II.C. of this final rule correction and correcting 
amendment, we inadvertently excluded a hospital that converted to CAH 
status after January 24, 2021, the cut-off date for CAH exclusion from 
the FY 2022 wage index. (CMS Certification Number (CCN) 230118). Also, 
as discussed in section II.C. of this final rule correction and 
correcting amendment, CCN 360259 is incorrectly listed as reclassified 
to CBSA 19124. The correct reclassification area is to its geographic 
``home'' of CBSA 45780. As a result, as discussed previously, we are 
making changes to the FY 2022 wage indexes. Because the wage indexes 
are one of the inputs used to determine the out-migration adjustment, 
some of the out-migration adjustments changed. Therefore, we are making 
corresponding changes to some of the out-migration adjustments listed 
in Table 4A.
    Table 6B.--New Procedure Codes--FY 2022. We are correcting this 
table to reflect the assignment of procedure codes XW033A7 
(Introduction of ciltacabtagene autoleucel into peripheral vein, 
percutaneous approach, new technology group 7) and XW043A7 
(Introduction of ciltacabtagene autoleucel into central vein, 
percutaneous approach, new technology group 7) to Pre-MDC MS-DRG 018 
(Chimeric Antigen Receptor (CAR) T-cell and Other Immunotherapies). 
Table 6B inadvertently omitted Pre-MDC MS-DRG 018 in Column E (MS-DRG) 
for assignment of these codes. Effective with discharges on and after 
April 1, 2022, conforming changes will be reflected in the Version 39.1 
ICD-10 MS-DRG Definitions Manual and ICD-10 MS-DRG Grouper and Medicare 
Code Editor software.
    Table 6P.--ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes--FY 
2022. We are correcting Table 6P.1d associated with the final rule to 
reflect three procedure codes submitted by the requestor that were 
inadvertently omitted, resulting in 79 procedure codes listed instead 
of 82 procedure codes as indicated in the final rule (see pages 44808 
and 44809).
    Table 18.--Final FY 2022 Medicare DSH Uncompensated Care Payment 
Factor 3. For the FY 2022 IPPS/LTCH PPS final rule, we published a list 
of hospitals that we identified to be subsection (d) hospitals and 
subsection (d) Puerto Rico hospitals projected to be eligible to 
receive interim uncompensated care payments for FY 2022. As stated in 
the FY 2022 IPPS/LTCH PPS final rule (86 FR 45249), we allowed the 
public an additional period after the issuance of the final rule to 
review and submit comments on the accuracy of the list of mergers that 
we identified in the final rule. Based on the comments received during 
this additional period, we are updating this table to reflect the 
merger information received in response to the final rule and to revise 
the Factor 3 calculations for purposes of determining uncompensated 
care payments for the FY 2022 IPPS/LTCH PPS final rule. We are revising 
Factor 3 for all hospitals to reflect the updated merger information 
received in response to the final rule. We are also revising the amount 
of the total uncompensated care payment calculated for each DSH 
eligible hospital. The total uncompensated care payment that a hospital 
receives is used to calculate the amount of the interim uncompensated 
care payments the hospital receives per discharge;

[[Page 58022]]

accordingly, we have also revised these amounts for all DSH eligible 
hospitals. These corrections will be reflected in Table 18 and the 
Medicare DSH Supplemental Data File. Per discharge uncompensated care 
payments are included when determining total payments for purposes of 
all of the budget neutrality factors and the final outlier threshold. 
As a result, these corrections to uncompensated care payments required 
the recalculation of all the budget neutrality factors as well as the 
outlier fixed-loss cost threshold. We note that the fixed-loss cost 
threshold was unchanged after these recalculations. In section IV.C. of 
this final rule correction and correcting amendment, we have made 
corresponding revisions to the discussion of the ``Effects of the 
Changes to Medicare DSH and Uncompensated Care Payments for FY 2022'' 
for purposes of the Regulatory Impact Analysis in Appendix A of the FY 
2022 IPPS/LTCH PPS final rule to reflect the corrections discussed 
previously and to correct minor typographical errors. The files that 
are available on the internet have been updated to reflect the 
corrections discussed in this final rule correction and correcting 
amendment.
    In addition, we are correcting the inadvertent omission of the 
following 32 ICD-10-PCS codes describing percutaneous cardiovascular 
procedures involving one, two, three or four arteries from the GROUPER 
logic for MS-DRG 246 (Percutaneous Cardiovascular Procedures with Drug-
Eluting Stent with MCC or 4+ Arteries or Stents) and MS-DRG 248 
(Percutaneous Cardiovascular Procedures with Non-Drug-Eluting Stent 
with MCC or 4+ Arteries or Stents).

------------------------------------------------------------------------
   ICD[dash]10[dash]PCS code                   Description
------------------------------------------------------------------------
02703Z6.......................  Dilation of coronary artery, one artery,
                                 bifurcation, percutaneous approach.
02703ZZ.......................  Dilation of coronary artery, one artery,
                                 percutaneous approach.
02704Z6.......................  Dilation of coronary artery, one artery,
                                 bifurcation, percutaneous endoscopic
                                 approach.
02704ZZ.......................  Dilation of coronary artery, one artery,
                                 percutaneous endoscopic approach.
02C03Z6.......................  Extirpation of matter from coronary
                                 artery, one artery, bifurcation,
                                 percutaneous approach.
02C03ZZ.......................  Extirpation of matter from coronary
                                 artery, one artery, percutaneous
                                 approach.
02C04Z6.......................  Extirpation of matter from coronary
                                 artery, one artery, bifurcation,
                                 percutaneous endoscopic approach.
02C04ZZ.......................  Extirpation of matter from coronary
                                 artery, one artery, percutaneous
                                 endoscopic approach.
02713Z6.......................  Dilation of coronary artery, two
                                 arteries, bifurcation, percutaneous
                                 approach.
02713ZZ.......................  Dilation of coronary artery, two
                                 arteries, percutaneous approach.
02714Z6.......................  Dilation of coronary artery, two
                                 arteries, bifurcation, percutaneous
                                 endoscopic approach.
02714ZZ.......................  Dilation of coronary artery, two
                                 arteries, percutaneous endoscopic
                                 approach.
02C13Z6.......................  Extirpation of matter from coronary
                                 artery, two arteries, bifurcation,
                                 percutaneous approach.
02C13ZZ.......................  Extirpation of matter from coronary
                                 artery, two arteries, percutaneous
                                 approach.
02C14Z6.......................  Extirpation of matter from coronary
                                 artery, two arteries, bifurcation,
                                 percutaneous endoscopic approach.
02C14ZZ.......................  Extirpation of matter from coronary
                                 artery, two arteries, percutaneous
                                 endoscopic approach.
02723Z6.......................  Dilation of coronary artery, three
                                 arteries, bifurcation, percutaneous
                                 approach.
02723ZZ.......................  Dilation of coronary artery, three
                                 arteries, percutaneous approach.
02724Z6.......................  Dilation of coronary artery, three
                                 arteries, bifurcation, percutaneous
                                 endoscopic approach.
02724ZZ.......................  Dilation of coronary artery, three
                                 arteries, percutaneous endoscopic
                                 approach.
02C23Z6.......................  Extirpation of matter from coronary
                                 artery, three arteries, bifurcation,
                                 percutaneous approach.
02C23ZZ.......................  Extirpation of matter from coronary
                                 artery, three arteries, percutaneous
                                 approach.
02C24Z6.......................  Extirpation of matter from coronary
                                 artery, three arteries, bifurcation,
                                 percutaneous endoscopic approach.
02C24ZZ.......................  Extirpation of matter from coronary
                                 artery, three arteries, percutaneous
                                 endoscopic approach.
02733Z6.......................  Dilation of coronary artery, four or
                                 more arteries, bifurcation,
                                 percutaneous approach.
02733ZZ.......................  Dilation of coronary artery, four or
                                 more arteries, percutaneous approach.
02734Z6.......................  Dilation of coronary artery, four or
                                 more arteries, bifurcation,
                                 percutaneous endoscopic approach.
02734ZZ.......................  Dilation of coronary artery, four or
                                 more arteries, percutaneous endoscopic
                                 approach.
02C33Z6.......................  Extirpation of matter from coronary
                                 artery, four or more arteries,
                                 bifurcation, percutaneous approach.
02C33ZZ.......................  Extirpation of matter from coronary
                                 artery, four or more arteries,
                                 percutaneous approach.
02C34Z6.......................  Extirpation of matter from coronary
                                 artery, four or more arteries,
                                 bifurcation, percutaneous endoscopic
                                 approach.
02C34ZZ.......................  Extirpation of matter from coronary
                                 artery, four or more arteries,
                                 percutaneous endoscopic approach.
------------------------------------------------------------------------

    We have corrected the ICD-10 MS-DRG Definitions Manual Version 39 
and the ICD-10 MS-DRG GROUPER and MCE Version 39 Software to correctly 
reflect the inclusion of these codes in the arterial logic lists for 
MS-DRGs 246 and 248 for FY 2022.

III. Waiver of Proposed Rulemaking and Delay in Effective Date

    Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), 
the agency is required to publish a notice of the proposed rulemaking 
in the Federal Register before the provisions of a rule take effect. 
Similarly, section 1871(b)(1) of the Act requires the Secretary to 
provide for notice of the proposed rulemaking in the Federal Register 
and provide a period of not less than 60 days for public comment. In 
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of 
the Act mandate a 30-day delay in effective date after issuance or 
publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA 
provide for exceptions from the notice and comment and delay in 
effective date APA requirements; in cases in which these exceptions 
apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide 
exceptions from the notice and 60-day comment period and delay in 
effective date requirements of the Act as well. Section 553(b)(B) of 
the APA and section 1871(b)(2)(C) of the Act authorize an agency to 
dispense with normal rulemaking requirements for good cause if the 
agency makes a finding that the notice and comment process are 
impracticable, unnecessary, or contrary to the public interest. In 
addition, both section 553(d)(3) of the APA and section 
1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay 
in effective date where such delay is contrary to the public interest 
and an agency includes a statement of support.
    We believe that this final rule correction and correcting amendment 
does not constitute a rule that would be subject to the notice and 
comment or

[[Page 58023]]

delayed effective date requirements. This document corrects technical 
and typographical errors in the preamble, regulations text, addendum, 
payment rates, tables, and appendices included or referenced in the FY 
2022 IPPS/LTCH PPS final rule, but does not make substantive changes to 
the policies or payment methodologies that were adopted in the final 
rule. As a result, this final rule correction and correcting amendment 
is intended to ensure that the information in the FY 2022 IPPS/LTCH 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 providers to receive appropriate payments in as timely a 
manner as possible, and to ensure that the FY 2022 IPPS/LTCH PPS final 
rule accurately reflects our policies. Furthermore, such procedures 
would be unnecessary, as we are not altering our payment methodologies 
or policies, but rather, we are simply implementing correctly the 
methodologies and policies that we previously proposed, requested 
comment on, and subsequently finalized. This final rule correction and 
correcting amendment is intended solely to ensure that the FY 2022 
IPPS/LTCH PPS final rule accurately reflects these payment 
methodologies and policies. Therefore, 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 final rule correction and correcting amendment 
because it is in the public's interest for providers to receive 
appropriate payments in as timely a manner as possible, and to ensure 
that the FY 2022 IPPS/LTCH PPS final rule accurately reflects our 
policies.

IV. Correction of Errors

    In FR Doc. 2021-16519 of August 13, 2021 (86 FR 44774), we are 
making the following corrections:

A. Correction of Errors in the Preamble

    1. On page 44878, second column, last paragraph, line 10, ``15 
technologies'' is corrected to read ``technologies.''
    2. On page 44889, lower two-thirds of the page, third column, 
partial paragraph, line 10, the procedure code ``0DQ540ZZ'' is 
corrected to read ``0DQ54ZZ.''
    3. On page 44960, in the untitled table, last 2 lines are corrected 
to read as follows:

------------------------------------------------------------------------
              MDC                    MS-DRG            MS-DRG title
------------------------------------------------------------------------
 
                              * * * * * * *
08.............................             521  Hip Replacement with
                                                  Principal Diagnosis of
                                                  Hip Fracture with MCC.
08.............................             522  Hip Replacement with
                                                  Principal Diagnosis of
                                                  Hip Fracture without
                                                  MCC.
------------------------------------------------------------------------

    4. On page 45047:
    a. Second column, first full paragraph, lines 21 through 24, the 
sentence ``We summarize comments related to this comment solicitation 
and provide our responses as well as our finalized policy in section 
XXX of this final rule.'' is corrected to read ``We summarize comments 
related to this comment solicitation and provide our responses in 
section II.F.7. of the preamble of this final rule.''.
    b. Third column, first full paragraph, line 28, the reference 
``section XXX'' is corrected to read ``section II.F.8.''.
    5. On page 45048, second column, second full paragraph, lines 20 
through 24, the sentence ``We summarize comments related to this 
comment solicitation and provide our responses as well as our finalized 
policy in section XXX of this final rule.'' is corrected to read ``We 
summarize comments related to this comment solicitation and provide our 
responses in section II.F.7. of the preamble of this final rule.''.
    6. On page 45049:
    a. Second column:
    (1) First full paragraph, line 12, the reference, ``section XXX of 
this final rule'' is corrected to read ``section II.F.8. of the 
preamble of this final rule''.
    (2) Second full paragraph, lines 1 and 2, the reference, ``section 
XXX of this final rule'' is corrected to read ``section II.F.7. J95.851 
(Ventilator associated pneumonia) and one of the following: B96.1 
(Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases 
classified elsewhere), B96.20 (Unspecified Escherichia coli [E. coli] 
as the cause of diseases classified elsewhere), B96.21 (Shiga toxin-
producing Escherichia coli [E. coli] [STEC] O157 as the cause of 
diseases classified elsewhere), B96.22 (Other specified Shiga toxin-
producing Escherichia coli [E. coli] [STEC] as the cause of diseases 
classified elsewhere), B96.23 (Unspecified Shiga toxin-producing 
Escherichia coli [E. coli] [STEC] as the cause of diseases classified 
elsewhere, B96.29 (Other Escherichia coli [E. coli] as the cause of 
diseases classified elsewhere), B96.3 (Hemophilus influenzae [H. 
influenzae] as the cause of diseases classified elsewhere, B96.5 
(Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of 
diseases classified elsewhere), or B96.89 (Other specified bacterial 
agents as the cause of diseases classified elsewhere) for VABP.''
    10. On page 45158, third column, first partial paragraph, last line 
the phrase, ``technology group 5).'' is corrected to read ``technology 
group 5) in combination with the following ICD-10-CM codes: Y95 
(Nosocomial condition) and one of the following: J14.0 (Pneumonia due 
to Hemophilus influenzae) J15.0 (Pneumonia due to Klebsiella 
pneumoniae), J15.1 (Pneumonia due to Pseudomonas), J15.5 (Pneumonia due 
to Escherichia coli), J15.6 (Pneumonia due to other Gram-negative 
bacteria), or J15.8 (Pneumonia due to other specified bacteria) for 
HABP and ICD10-PCS codes: XW033A6 (Introduction of cefiderocol 
antinfective into peripheral vein, percutaneous approach, new 
technology group 6) or XW043A6 (Introduction of cefiderocol anti-
infective into central vein, percutaneous approach, new technology 
group 6) in combination with the following ICD-10-CM codes: J95.851 
(Ventilator associated pneumonia) and one of the following: B96.1 
(Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases 
classified elsewhere), B96.20 (Unspecified Escherichia coli [E. coli] 
as the cause of diseases classified elsewhere), B96.21 (Shiga toxin-
producing Escherichia coli [E. coli]

[[Page 58024]]

[STEC] O157 as the cause of diseases classified elsewhere), B96.22 
(Other specified Shiga toxin-producing Escherichia coli [E. coli] 
[STEC] as the cause of diseases classified elsewhere), B96.23 
(Unspecified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as 
the cause of diseases classified elsewhere, B96.29 (Other Escherichia 
coli [E. coli] as the cause of diseases classified elsewhere), B96.3 
(Hemophilus influenzae [H. influenzae] as the cause of diseases 
classified elsewhere, B96.5 (Pseudomonas (aeruginosa) 
(mallei)(pseudomallei) as the cause of diseases classified elsewhere), 
or B96.89 (Other specified bacterial agents as the cause of diseases 
classified elsewhere) for VABP.''
    11. On page 45291, middle of the page, the table titled ``Table 
V.H-11: Previously Established and Newly Updated Performance Standards 
for the FY 2024 Program Year'' is corrected to read as follows:

Table V.H-11--Previously Established and Estimated Performance Standards
                      for the FY 2024 Program Year
------------------------------------------------------------------------
                                            Achievement
           Measure short name                threshold       Benchmark
------------------------------------------------------------------------
                        Clinical Outcomes Domain
------------------------------------------------------------------------
MORT-30-AMI ...........................        0.869247        0.887868
MORT-30-HF ............................        0.882308        0.907773
MORT-30-PN (updated cohort) ...........        0.840281        0.872976
MORT-30-COPD ..........................        0.916491        0.934002
MORT-30-CABG ..........................        0.969499        0.980319
COMP-HIP-KNEE * .......................        0.025396        0.018159
------------------------------------------------------------------------
[diams] As discussed in section V.H.4.b. of this final rule, we are
  finalizing the updates to the FY 2024 baseline periods for measures
  included in the Person and Community Engagement, Safety, and
  Efficiency and Cost Reduction domains to use CY 2019. Therefore, the
  performance standards displayed in this table for the Safety domain
  measures were calculated using CY 2019 data.
* Lower values represent better performance.
 Previously established performance standards.

    12. On page 45293, top of the page, the table titled ``V.H-13 
Previously Established and Estimated Performance Standards for the FY 
2025 Program Year'' is corrected to read as follows:

Table V.H-13--Previously Established and Estimated Performance Standards
                      for the FY 2025 Program Year
------------------------------------------------------------------------
                                            Achievement
           Measure short name                threshold       Benchmark
------------------------------------------------------------------------
                        Clinical Outcomes Domain
------------------------------------------------------------------------
MORT-30-AMI ...........................        0.872624        0.889994
MORT-30-HF ............................        0.883990        0.910344
MORT-30-PN (updated cohort) ...........        0.841475        0.874425
MORT-30-COPD ..........................        0.915127        0.932236
MORT-30-CABG ..........................        0.970100        0.979775
COMP-HIP-KNEE * .......................        0.025332        0.017946
------------------------------------------------------------------------
* Lower values represent better performance.
 Previously established performance standards.

    13. On page 45294, top of page, the table titled ``V.H-14 
Previously Established and Estimated Performance Standards for the FY 
2026 Program Year'' is corrected to read as follows:

Table V.H-14--Previously Established and Estimated Performance Standards
                      for the FY 2026 Program Year
------------------------------------------------------------------------
                                            Achievement
           Measure short name                threshold       Benchmark
------------------------------------------------------------------------
                        Clinical Outcomes Domain
------------------------------------------------------------------------
MORT-30-AMI ...........................        0.874426        0.890687
MORT-30-HF ............................        0.885949        0.912874
MORT-30-PN (updated cohort) ...........        0.843369        0.877097
MORT-30-COPD ..........................        0.914691        0.932157
MORT-30-CABG ..........................        0.970568        0.980473
COMP-HIP-KNEE * .......................        0.024019        0.016873
------------------------------------------------------------------------
* Lower values represent better performance.

[[Page 58025]]

 
 Previously established performance standards.

    14. On page 45312, second column, first full paragraph, lines 7 
through 9, the phrase ``rejection of the cost report if the submitted 
IRIS GME and IME FTEs do match'' is corrected to read ``rejection of 
the cost report if the submitted IRIS GME and IME FTEs do not match''.
    15. On page 45386, third column, first full paragraph, line 12, the 
phrase ``mellitus and who either'' is corrected to read ``mellitus, 
who''.
    16. On page 45400, top of the page, the table titled ``Measures for 
the FY 2024 Payment Determination and Subsequent Years'', is corrected 
by--
    a. Correcting the title to read ``Measures for the FY 2023 Payment 
Determination and Subsequent Years''.
    b. Removing the heading ``Claims and Electronic Data Measures'' and 
the entry ``Hybrid HWR**'' (rows 20 and 21).
    c. Following the table, lines 3 through 8, removing the second 
table note.
    17. On page 45404, bottom of the page, after the table titled 
``Measures for the FY 2025 Payment Determination and Subsequent 
Years'', in the third note to the table, line 10, the parenthetical 
phrase ``(July 1, 2023-June 30, 2023)'' is corrected to read ``(July 1, 
2022-June 30, 2023)''.

B. Correction of Errors in the Addendum

    1. On page 45532, bottom of the page, the table titled ``Summary of 
FY 2022 Budget Neutrality Factors'' is corrected to read as follows:

              Summary of FY 2022 Budget Neutrality Factors
------------------------------------------------------------------------
 
------------------------------------------------------------------------
MS[dash]DRG Reclassification and Recalibration Budget           1.000107
 Neutrality Factor......................................
Wage Index Budget Neutrality Factor.....................        1.000715
Reclassification Budget Neutrality Factor...............        0.986741
*Rural Floor Budget Neutrality Factor...................        0.992868
Rural Demonstration Budget Neutrality Factor............        0.999361
Low Wage Index Hospital Policy Budget Neutrality Factor.        0.998029
Transition Budget Neutrality Factor.....................        0.999859
------------------------------------------------------------------------
* The rural floor budget neutrality factor is applied to the national
  wage indexes while the rest of the budget neutrality adjustments are
  applied to the standardized amounts.

    2. On page 45537, first column, first full paragraph, lines 4 
through 10, the parenthetical phrase ``(estimated capital outlier 
payments of $ 430,689,396 divided by (estimated capital outlier 
payments of $430,689,396 plus the estimated total capital Federal 
payment of $7,676,990,253)).'' is corrected to read ``(estimated 
capital outlier payments of $430,698,533 divided by (estimated capital 
outlier payments of $430,698,533 plus the estimated total capital 
Federal payment of $7,676,964,386)).''.
    3. On page 45542, third column, last paragraph, lines 23 and 24, 
the figure ``$5,326,356,951'' is corrected to read ``$5,326,379,560''.
    4. On page 45543:
    a. Top of the page, first column, first partial paragraph:
    (1) Line 1, the figure ``$100,164,666,975'' is corrected to read 
``$100,165,281,272''.
    (2) Line 17, the figure ``$31,108'' is corrected to read 
``$31,109''.
    b. Middle of the page, the untitled table is corrected to read as 
follows:

------------------------------------------------------------------------
                                             Operating
                                           standardized       Capital
                                              amounts     Federal rate *
------------------------------------------------------------------------
National................................           0.949        0.947078
------------------------------------------------------------------------
* The adjustment factor for the capital Federal rate includes an
  adjustment to the estimated percentage of FY 2022 capital outlier
  payments for capital outlier reconciliation, as discussed previously
  and in section III. A. 2 in the Addendum of this final rule.

    5. On page 45545, the table titled ``CHANGES FROM FY 2021 
STANDARDIZED AMOUNTS TO THE FY 2022 STANDARDIZED AMOUNTS'' is corrected 
to read as follows:
BILLING CODE 4120-01-P

[[Page 58026]]

[GRAPHIC] [TIFF OMITTED] TR20OC21.000

BILLING CODE 4120-01-C
    6. On page 45553, second column, last paragraph, line 9, the figure 
``$472.60'' is corrected to read ``$472.59''.
    7. On page 45554, top of the page, in the table titled ``COMPARISON 
OF FACTORS AND ADJUSTMENTS: FY 2021 CAPITAL FEDERAL RATE AND THE FY 
2022 CAPITAL FEDERAL RATE'', the list entry (row 5) is corrected to 
read as follows:

    Comparison of Factors and Adjustments: FY 2021 Capital Federal Rate and the FY 2022 Capital Federal Rate
----------------------------------------------------------------------------------------------------------------
                                                      FY 2021         FY 2022         Change      Percent change
----------------------------------------------------------------------------------------------------------------
 
                                                  * * * * * * *
Capital Federal Rate............................         $466.21         $472.59          1.0137        \4\ 1.37
----------------------------------------------------------------------------------------------------------------

    8. On page 45570:
    a. The table titled ``TABLE 1A.--NATIONAL ADJUSTED OPERATING 
STANDARDIZED AMOUNTS, LABOR/NONLABOR (67.6 PERCENT LABOR SHARE/32.4 
PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1)--FY 2022'' is 
corrected to read as follows:

    Table 1A--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (67.6 Percent Labor Share/32.4 Percent Nonlabor Share if Wage Index Is
                                                                Greater Than 1)--FY 2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is   Hospital submitted quality data and  Hospital did not submit quality data  Hospital did not submit quality data
 a meaningful EHR user  (update = 2.0       is not a meaningful EHR user          and is a meaningful EHR user        and is not a meaningful EHR user
               percent)                       (update = -0.025 percent)             (update = 1.325 percent)               (update = -0.7 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
       Labor             Nonlabor             Labor             Nonlabor            Labor             Nonlabor            Labor             Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
       $4,138.24           $1,983.41          $4,056.08          $1,944.03          $4,110.85          $1,970.28          $4,028.70          $1,930.91
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 58027]]

    b. The table titled ``TABLE 1B.--NATIONAL ADJUSTED OPERATING 
STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/38 PERCENT 
NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)--FY 2022'' is 
corrected to read as follows:

 Table 1B--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share if Wage Index is Less Than
                                                                 or Equal to 1)--FY 2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is   Hospital submitted quality data and  Hospital did not submit quality data  Hospital did not submit quality data
 a meaningful EHR user  (update = 2.0       is not a meaningful EHR user          and is a meaningful EHR user        and is not a meaningful EHR user
               percent)                       (update = -0.025 percent)             (update = 1.325 percent)               (update = -0.7 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
       Labor             Nonlabor             Labor             Nonlabor            Labor             Nonlabor            Labor             Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
       $3,795.42           $2,326.23          $3,720.07          $2,280.04          $3,770.30          $2,310.83          $3,694.96          $2,264.65
--------------------------------------------------------------------------------------------------------------------------------------------------------

    9. On page 45571, the top of page:
    a. The table titled ``Table 1C.--ADJUSTED OPERATING STANDARDIZED 
AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL: 62 
PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS 
LESS THAN OR EQUAL TO 1)--FY 2022'' is corrected to read as follows:

  Table 1C--Adjusted Operating Standardized Amounts for Hospitals in Puerto Rico, Labor/Nonlabor (National: 62 Percent Labor Share/38 Percent Nonlabor
                                              Share Because Wage Index Is Less Than or Equal to 1)--FY 2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                            Rates if wage index greater than 1          Hospital is a meaningful EHR    Hospital is NOT a meaningful EHR
                                     ------------------------------------------------ user and wage index less than or  user and wage index less than or
                                                                                         equal to 1  (update = 2.0)       equal to 1  (update = 1.325)
                                               Labor                 Nonlabor        -------------------------------------------------------------------
                                                                                           Labor           Nonlabor          Labor           Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ National........................  Not Applicable........  Not Applicable........       $3,795.42        $2,326.23        $3,770.30        $2,310.83
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ For FY 2022, there are no CBSAs in Puerto Rico with a national wage index greater than 1.

    b. The table titled ``TABLE 1D.--CAPITAL STANDARD FEDERAL PAYMENT 
RATE--FY 2022'' is corrected to read as follows:

        Table 1D--Capital Standard Federal Payment Rate--FY 2022
------------------------------------------------------------------------
                                                               Rate
------------------------------------------------------------------------
National...............................................         $472.59
------------------------------------------------------------------------

C. Correction of Errors in the Appendices

    1. On pages 45576 through 45578, the table titled ``Table I.--
Impact Analysis of Changes to the IPPS for Operating Costs for FY 
2022'' is corrected to read as follows:
BILLING CODE 4120-01-P

[[Page 58028]]

[GRAPHIC] [TIFF OMITTED] TR20OC21.001


[[Page 58029]]


[GRAPHIC] [TIFF OMITTED] TR20OC21.002


[[Page 58030]]


[GRAPHIC] [TIFF OMITTED] TR20OC21.003

BILLING CODE 4120-01-C
    2. On page 45579, third column, first paragraph, line 23, the 
figure ``1.000712'' is corrected to read ``1.000715''.

[[Page 58031]]

    3. On page 45580, lower three-fourths of the page, first column, 
third full paragraph, line 6, the figure ``0.986737'' is corrected to 
read ``0.986741''.
    4. On pages 45582 and 45583, the table titled ``Table II.--Impact 
Analysis of Changes for FY 2022 Acute Care Hospital Operating 
Prospective Payment System (Payments Per Discharge)'' is corrected to 
read as follows:

    Table II--Impact Analysis of Changes for FY 2022 Acute Care Hospital Operating Prospective Payment System
                                            [Payments per discharge]
----------------------------------------------------------------------------------------------------------------
                                                                     Estimated       Estimated
                                                     Number of      average  FY     average FY        FY 2022
                                                     hospitals     2021 payment    2022 payment       changes
                                                                   per discharge   per discharge
                                                             (1)             (2)             (3)             (4)
----------------------------------------------------------------------------------------------------------------
All Hospitals...................................           3,195          13,109          13,448             2.6
By Geographic Location:
    Urban hospitals.............................           2,459          13,454          13,800             2.6
    Rural hospitals.............................             736           9,901          10,178             2.8
Bed Size (Urban):
    0-99 beds...................................             634          10,723          11,011             2.7
    100-199 beds................................             754          11,015          11,305             2.6
    200-299 beds................................             427          12,251          12,551             2.4
    300-499 beds................................             421          13,496          13,847             2.6
    500 or more beds............................             223          16,568          16,992             2.6
Bed Size (Rural):
    0-49 beds...................................             311           8,556           8,921             4.3
    50-99 beds..................................             253           9,419           9,644             2.4
    100-149 beds................................              94           9,789          10,033             2.5
    150-199 beds................................              39          10,519          10,788             2.6
    200 or more beds............................              39          11,465          11,784             2.8
Urban by Region:
    New England.................................             112          14,858          15,253             2.7
    Middle Atlantic.............................             304          15,432          15,814             2.5
    East North Central..........................             381          12,838          13,150             2.4
    West North Central..........................             160          13,121          13,475             2.7
    South Atlantic..............................             402          11,710          12,049             2.9
    East South Central..........................             144          11,290          11,576             2.5
    West South Central..........................             364          11,806          12,072             2.3
    Mountain....................................             172          13,698          14,054             2.6
    Pacific.....................................             370          17,230          17,664             2.5
    Puerto Rico.................................              50           8,491           8,637             1.7
Rural by Region:
    New England.................................              19          13,990          14,463             3.4
    Middle Atlantic.............................              50           9,736           9,988             2.6
    East North Central..........................             113          10,361          10,592             2.2
    West North Central..........................              89          10,638          10,932             2.8
    South Atlantic..............................             114           9,032           9,302               3
    East South Central..........................             144           8,732           8,955             2.6
    West South Central..........................             135           8,292           8,540               3
    Mountain....................................              48          12,134          12,359             1.9
    Pacific.....................................              24          13,865          14,588             5.2
By Payment Classification:
    Urban hospitals.............................           1,983          12,673          13,003             2.6
    Rural areas.................................           1,212          13,796          14,148             2.6
Teaching Status:
    Nonteaching.................................           2,031          10,677          10,963             2.7
    Fewer than 100 residents....................             907          12,388          12,694             2.5
    100 or more residents.......................             257          18,938          19,437             2.6
Urban DSH:
    Non-DSH.....................................             502          11,749          12,054             2.6
    100 or more beds............................           1,227          13,015          13,355             2.6
    Less than 100 beds..........................             348           9,559           9,820             2.7
Rural DSH:
    SCH.........................................             265          11,906          12,203             2.5
    RRC.........................................             608          14,380          14,747             2.6
    100 or more beds............................              30          12,115          12,298             1.5
    Less than 100 beds..........................             215           7,778           8,025             3.2
Urban teaching and DSH:
    Both teaching and DSH.......................             679          14,116          14,483             2.6
    Teaching and no DSH.........................              74          12,825          13,127             2.4
    No teaching and DSH.........................             896          10,850          11,137             2.6
    No teaching and no DSH......................             334          10,824          11,110             2.6
Special Hospital Types:

[[Page 58032]]

 
    RRC.........................................             523          14,478          14,859             2.6
    SCH.........................................             305          12,053          12,356             2.5
    MDH.........................................             153           9,169           9,404             2.6
    SCH and RRC.................................             154          12,475          12,746             2.2
    MDH and RRC.................................              27          10,622          10,853             2.2
Type of Ownership:
    Voluntary...................................           1,881          13,321          13,667             2.6
    Proprietary.................................             828          11,473          11,769             2.6
    Government..................................             486          14,109          14,466             2.5
Medicare Utilization as a Percent of Inpatient
 Days:
    0-25........................................             643          15,158          15,535             2.5
    25-50.......................................           2,110          12,926          13,268             2.6
    50-65.......................................             367          10,773          11,010             2.2
    Over 65.....................................              50           8,132           8,431             3.7
FY 2022 Reclassifications by the Medicare
 Geographic Classification Review Board:
    All Reclassified Hospitals..................             934          13,592          13,944             2.6
    Non-Reclassified Hospitals..................           2,261          12,772          13,102             2.6
    Urban Hospitals Reclassified................             749          14,261          14,619             2.5
    Urban Nonreclassified Hospitals.............           1,723          12,851          13,187             2.6
    Rural Hospitals Reclassified Full Year......             300          10,087          10,341             2.5
    Rural Nonreclassified Hospitals Full Year...             423           9,610           9,929             3.3
    All Section 401 Reclassified Hospitals......             532          14,968          15,343             2.5
    Other Reclassified Hospitals (Section                     56           9,149           9,429             3.1
     1886(d)(8)(B)).............................
----------------------------------------------------------------------------------------------------------------

    5. On page 45584, bottom third of the page, third column, partial 
paragraph:
    a. Line 7, the figure ``$151 million'' is corrected to read ``$158 
million''.
    b. Line 10, the figure ``$50 million'' is corrected to read ``$57 
million''.
    c. Lines 15 and 16, the phrase ``for which we are approving new 
technology add-on payments'' is corrected to read ``for which we are 
approving or conditionally approving new technology add-on payments''.
    6. On page 45585:
    a. Top third of the page:
    (1) In the untitled table, the third and fourth column headings and 
the entries at rows 6 and 9 are corrected to read as follows:

----------------------------------------------------------------------------------------------------------------
                                                                                           Pathway  (QIDP, LPAD,
        Technology name           Estimated cases      FY 2022 NTAP    Estimated FY 2022      or breakthrough
                                                          amount          total impact            device)
----------------------------------------------------------------------------------------------------------------
 
                                                  * * * * * * *
Fetroja (HABP/VABP)............                379          $8,579.84      $3,251,759.36  QIDP.
 
                                                  * * * * * * *
Recarbrio (HABP/VABP)..........                928           9,576.51       8,887,001.28  QIDP.
 
                                                  * * * * * * *
----------------------------------------------------------------------------------------------------------------

    (2) Following the first untitled table, second column, partial 
paragraph, last line, the figure ``$498 million'' is corrected to read 
``$514 million''.
    b. Middle third of the page, in the untitled table, the third and 
fourth column headings and the entries at rows 2 and 4 are corrected to 
read as follows:

----------------------------------------------------------------------------------------------------------------
                                                                               FY 2022 NTAP    Estimated FY 2022
                    Technology name                       Estimated cases         amount          total impact
----------------------------------------------------------------------------------------------------------------
 
                                                  * * * * * * *
Abecma.................................................                484        $272,675.00    $131,974,700.00
 

[[Page 58033]]

 
                                                  * * * * * * *
Tecartus...............................................                 15         259,350.00       3,890,250.00
 
                                                  * * * * * * *
----------------------------------------------------------------------------------------------------------------

    7. On pages 45587 and 45588, the table titled ``Modeled 
Uncompensated Care Payments for Estimated FY 2022 DSHs by Hospital 
Type: Model Uncompensated Care Payments ($ in Millions)--from FY 2021 
to FY 2022'' is corrected to read as follows:
BILLING CODE 4120-01-P

[[Page 58034]]

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[[Page 58035]]


[GRAPHIC] [TIFF OMITTED] TR20OC21.005

BILLING CODE 4120-01-C
    8. On page 45588, lower half of the page, beginning with the second 
column, first full paragraph, line 1 with the phrase ``Rural hospitals, 
in general, are projected to experience'' and ending in the third 
column last paragraph with the phrase ``15.22 percent. All'' the 
paragraphs are corrected to read as follows:
    ``Rural hospitals, in general, are projected to experience larger 
decreases in uncompensated care payments than their urban counterparts. 
Overall, rural hospitals are projected to receive a 17.28 percent 
decrease in uncompensated care payments, which is a greater decrease 
than the overall hospital average, while urban hospitals are projected 
to receive a 12.99 percent decrease in uncompensated care payments, 
similar to the overall hospital average.
    By bed size, smaller rural hospitals are projected to receive the 
largest decreases in uncompensated care payments. Rural hospitals with 
0-99 beds are projected to receive an 18.97 percent payment decrease, 
and rural hospitals with 100-249 beds are projected to receive a 15.53 
percent decrease. In contrast, larger rural hospitals with 250+ beds 
are projected to receive a 14.16 percent payment decrease. Among urban 
hospitals, the smallest urban hospitals, those with 0-99 and 100-249 
beds, are projected to receive a decrease in uncompensated care 
payments that is greater than the overall hospital average, at 15.49 
and 15.50 percent, respectively. In contrast, the largest urban 
hospitals with 250+ beds are projected to receive a 12.02 percent 
decrease in uncompensated care payments, which is a smaller decrease 
than the overall hospital average.
    By region, rural hospitals are expected to receive larger than 
average decreases in uncompensated care payments in all Regions, except 
for rural hospitals in New England, which are projected to receive a 
decrease of 1.27 percent in uncompensated care payments, and rural 
hospitals in the East South Central Region, which are projected to 
receive a smaller than average decrease of 13.01 percent. Regionally, 
urban hospitals are projected to receive a more varied range of payment 
changes. Urban hospitals in the New England, Middle Atlantic, and 
Pacific Regions are projected to receive larger than average decreases 
in uncompensated care payments. Urban hospitals in the South Atlantic, 
East North Central, West North Central, West South Central, and 
Mountain Regions, as well as hospitals in Puerto Rico are projected to 
receive smaller than average decreases in uncompensated care payments. 
Urban hospitals in the East South Central Region are projected to 
receive an average decrease in uncompensated care payments.
    By payment classification, although hospitals in urban areas 
overall are expected to receive a 12.74 percent decrease in 
uncompensated care payments, hospitals in large urban areas are 
expected to see a decrease in uncompensated care payments of 13.52 
percent, while hospitals in other urban areas are expected to receive a 
decrease in uncompensated care payments of 11.21 percent. Rural 
hospitals are projected to receive the largest decrease of 14.23 
percent.
    Nonteaching hospitals are projected to receive a payment decrease 
of 13.4 percent, teaching hospitals with fewer than 100 residents are 
projected to receive a payment decrease of 12.94 percent, and teaching 
hospitals with 100+ residents have a projected payment decrease of 
13.39 percent. All of these decreases closely approximate the overall 
hospital average. Proprietary and voluntary hospitals are projected to 
receive smaller than average decreases of 11.56 and 12.61 percent 
respectively, while government hospitals are expected to receive a 
larger payment decrease of 15.21 percent. All''.
    9. On page 45589, first column, first partial paragraph, the phrase 
``hospitals with less than 50 percent Medicare utilization are 
projected to receive decreases in uncompensated care payments 
consistent with the overall hospital average percent change, while 
hospitals with 50-65 percent and greater than 65 percent Medicare 
utilization are projected to receive larger decreases of 20.79 and 
32.81 percent, respectively.'' is corrected to read as follows: 
``hospitals with less than 50 percent Medicare utilization are 
projected to receive decreases in uncompensated care payments 
consistent with the overall hospital average percent change, while 
hospitals with 50-65 percent and greater than 65 percent Medicare 
utilization are projected to receive larger decreases of 20.85 and 
32.86 percent, respectively.''

[[Page 58036]]

    10. On page 45598, third column, last paragraph, lines 21 through 
23, the sentence ``The estimated percentage increase for both rural 
reclassified and nonreclassified hospitals is 1.4 percent.'' is 
corrected to read ``The estimated percentage increase for rural 
reclassified hospitals is 1.3 percent, while the estimated percentage 
increase for rural nonreclassified hospitals is 1.4 percent.''
    11. On pages 45599 and 45600, the table titled ``TABLE III.--
COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2021 PAYMENTS COMPARED TO FY 
2022 PAYMENTS]'' is corrected to read as follows:
BILLING CODE 4120-01-P

[[Page 58037]]

[GRAPHIC] [TIFF OMITTED] TR20OC21.006


[[Page 58038]]


[GRAPHIC] [TIFF OMITTED] TR20OC21.007

    12. On page 45610:
    a. Second column, first partial paragraph:
    (1) Line 1, the figure ``$2.293'' is corrected to read ``$2.316''.
    (2) Line 11, the figure ``$0.65'' is corrected to read ``$0.68''.
    b. Third column, last full paragraph, last line, the figure 
``$2.293'' is corrected to read ``$2.316''.
    13. On page 45611, the table titled ``Table V--ACCOUNTING 
STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM 
FY 2021 TO FY 2022'' is corrected to read as follows:

[[Page 58039]]



------------------------------------------------------------------------
                 Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............  $2.316 billion.
From Whom to Whom.........................  Federal Government to IPPS
                                             Medicare Providers.
------------------------------------------------------------------------

List of Subjects in 42 CFR Part 413

    Diseases, Health facilities, Medicare, Puerto Rico, Reporting and 
recordkeeping requirements.

    As noted in section II.B. of the preamble, the Centers for Medicare 
& Medicaid Services is making the following correcting amendments to 42 
CFR part 413:

PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR 
END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED 
PAYMENT RATES FOR SKILLED NURSING FACILITIES

0
1. The authority citation for part 413 continues to read as follows:

    Authority: 42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), 
(i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww.

0
2. Amend Sec.  413.24 by:
0
a. In paragraph (f)(5)(i) introductory text, removing the phrase 
``except as provided in paragraph (f)(5)(i)(E) of this section:'' and 
adding in its place the phrase ``except as provided in paragraphs 
(f)(5)(i)(A)(2)(ii) and (f)(5)(i)(E) of this section:''; and
0
b. Revising paragraph (f)(5)(i)(A).
    The revision reads as follows:


Sec.  413.24  Adequate cost data and cost finding.

* * * * *
    (f) * * *
    (5) * * *
    (i) * * *
    (A) Teaching hospitals. For teaching hospitals, the Intern and 
Resident Information System (IRIS) data.
    (1) Data format. For cost reporting periods beginning on or after 
October 1, 2021, the IRIS data must be in the new XML IRIS format.
    (2) Resident counts. (i) Effective for cost reporting periods 
beginning on or after October 1, 2021, the IRIS data must contain the 
same total counts of direct GME FTE residents (unweighted and weighted) 
and IME FTE residents as the total counts of direct GME FTE and IME FTE 
residents reported in the provider's cost report.
    (ii) For cost reporting periods beginning on or after October 1, 
2021, and before October 1, 2022, the cost report is not rejected if 
the requirement in paragraph (f)(5)(i)(A)(2)(i) of this section is not 
met.
* * * * *

Karuna Seshasai,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2021-22724 Filed 10-19-21; 8:45 am]
BILLING CODE 4120-01-C