[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).
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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]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.004
[[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