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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations Availability of Certain Tables Exclusively Through the Internet on the CMS Website
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid Services 42 CFR Part 412
CMS1750F
RIN 0938AU40

Medicare Program; FY 2022 Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Updates for Fiscal Year Beginning October 1, 2021 FY 2022
Centers for Medicare &
Medicaid Services CMS, HHS.
ACTION: Final rule.
AGENCY:

This final rule updates the prospective payment rates, the outlier threshold, and the wage index for Medicare inpatient hospital services provided by Inpatient Psychiatric Facilities IPF, which include psychiatric hospitals and excluded psychiatric units of an acute care hospital or critical access hospital. This rule also updates and clarifies the IPF
teaching policy with respect to IPF
hospital closures and displaced residents and finalizes a technical change to one of the 2016-based IPF
market basket price proxies. In addition, this final rule finalizes proposals on quality measures and reporting requirements under the Inpatient Psychiatric Facilities Quality Reporting IPFQR Program. We note that this final rule does not finalize two proposals to remove quality measures. The changes finalized in this rule for the IPFQR
Program are effective for IPF discharges occurring during the Fiscal Year FY
beginning October 1, 2021 through September 30, 2022 FY 2022.
DATES: These regulations are effective on October 1, 2021.
FOR FURTHER INFORMATION CONTACT:
The IPF Payment Policy mailbox at IPFPaymentPolicy@cms.hhs.gov for general information.
Mollie Knight 410 7867948 or Eric Laib 410 7869759, for information regarding the market basket update or the labor related share.
Nick Brock 410 7865148 or Theresa Bean 410 7862287, for information regarding the regulatory impact analysis.
Lauren Lowenstein, 410 7864507, for information regarding the inpatient psychiatric facilities quality reporting program.

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SUMMARY:

SUPPLEMENTARY INFORMATION:

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Addendum A to this final rule summarizes the FY 2022 IPF PPS
payment rates, outlier threshold, cost of living adjustment factors COLA for Alaska and Hawaii, national and upper limit cost-to-charge ratios, and adjustment factors. In addition, the B
Addenda to this final rule shows the complete listing of ICD10 Clinical Modification CM and Procedure Coding System PCS codes, the FY
2022 IPF PPS comorbidity adjustment, and electroconvulsive therapy ECT
procedure codes. The A and B Addenda are available online at: https
www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/
InpatientPsychFacilPPS/tools.html.
Tables setting forth the FY 2022 Wage Index for Urban Areas Based on CoreBased Statistical Area CBSA Labor Market Areas and the FY 2022 Wage Index Based on CBSA Labor Market Areas for Rural Areas are available exclusively through the internet, on the CMS website at https www.cms.gov/
Medicare/Medicare-Fee-for-ServicePayment/IPFPPS/WageIndex.html.
I. Executive Summary A. Purpose This final rule updates the prospective payment rates, the outlier threshold, and the wage index for Medicare inpatient hospital services provided by Inpatient Psychiatric Facilities IPFs for discharges occurring during FY 2022 beginning October 1, 2021 through September 30, 2022. This rule also updates and clarifies the IPF
teaching policy with respect to IPF
hospital closures and displaced residents and finalizes a technical change to one of the 2016-based IPF
market basket price proxies. In addition, the final rule finalizes proposals to adopt quality measures and reporting requirements under the Inpatient Psychiatric Facilities Quality Reporting IPFQR Program.
B. Summary of the Major Provisions 1. Inpatient Psychiatric Facilities Prospective Payment System IPF PPS
For the IPF PPS, we are finalizing our proposal to Update IPF PPS teaching policy with respect to IPF hospital closures and displaced residents.
Replace one of the price proxies currently used for the For-profit Interest cost category in the 2016-based IPF
market basket with a similar price proxy.

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Adjust the 2016-based IPF market basket update 2.7 percent for economy-wide productivity 0.7
percentage point as required by section 1886s2Ai of the Social Security Act the Act, resulting in a final IPF
payment rate update of 2.0 percent for FY 2022.
Make technical rate setting changes:
The IPF PPS payment rates will be adjusted annually for inflation, as well as statutory and other policy factors.
This final rule updates:
++ The IPF PPS Federal per diem base rate from $815.22 to $832.94.
++ The IPF PPS Federal per diem base rate for providers who failed to report quality data to $816.61.
++ The Electroconvulsive therapy ECT payment per treatment from $350.97 to $358.60.
++ The ECT payment per treatment for providers who failed to report quality data to $351.57.
++ The labor-related share from 77.3
percent to 77.2 percent.
++ The wage index budget-neutrality factor from 0.9989 to 1.0017.
++ The fixed dollar loss threshold amount from $14,630 to $14,470 to maintain estimated outlier payments at 2 percent of total estimated aggregate IPF PPS payments.
2. Inpatient Psychiatric Facilities Quality Reporting IPFQR Program In this final rule, we are:
Adopting voluntary patient-level data reporting for chart-abstracted measures for data submitted for the FY
2023 payment determination and mandatory patient-level data reporting for chart-abstracted measures for the FY
2024 payment determination and subsequent years;
Revising our regulations at 42 CFR
412.434b3 by replacing the term QualityNet system administrator with QualityNet security official;
Adopting the Coronavirus disease 2019 COVID19 Vaccination Coverage Among Health Care Personnel HCP
measure for the FY 2023 payment determination and subsequent years;
Adopting the Follow-up After Psychiatric Hospitalization FAPH
measure for the FY 2024 payment determination and subsequent years;
and Removing the following two measures for FY 2024 payment determination and subsequent years:
++ Timely Transmission of Transition Record Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure and ++ Follow-up After Hospitalization for Mental Illness FUH measure.
Not finalizing our proposals to remove the following two measures for
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