Quiero saber acerca de...

42616

Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
D. Final Updates to the IPF PPS FacilityLevel Adjustments The IPF PPS includes facility-level adjustments for the wage index, IPFs located in rural areas, teaching IPFs, cost of living adjustments for IPFs located in Alaska and Hawaii, and IPFs with a qualifying ED.

lotter on DSK11XQN23PROD with RULES5

1. Wage Index Adjustment a. Background As discussed in the RY 2007 IPF PPS
final rule 71 FR 27061, RY 2009 IPF
PPS 73 FR 25719 and the RY 2010 IPF
PPS notices 74 FR 20373, in order to provide an adjustment for geographic wage levels, the labor-related portion of an IPFs payment is adjusted using an appropriate wage index. Currently, an IPFs geographic wage index value is determined based on the actual location of the IPF in an urban or rural area, as defined in 412.64b1iiA and C.
Due to the variation in costs and because of the differences in geographic wage levels, in the November 15, 2004
IPF PPS final rule, we required that payment rates under the IPF PPS be adjusted by a geographic wage index.
We proposed and finalized a policy to use the unadjusted, pre-floor, prereclassified IPPS hospital wage index to account for geographic differences in IPF labor costs. We implemented use of the pre-floor, pre-reclassified IPPS
hospital wage data to compute the IPF
wage index since there was not an IPFspecific wage index available. We believe that IPFs generally compete in the same labor market as IPPS hospitals so the pre-floor, pre-reclassified IPPS
hospital wage data should be reflective of labor costs of IPFs. We believe this pre-floor, pre-reclassified IPPS hospital wage index to be the best available data to use as proxy for an IPF specific wage index. As discussed in the RY 2007 IPF
PPS final rule 71 FR 27061 through 27067, under the IPF PPS, the wage index is calculated using the IPPS wage index for the labor market area in which the IPF is located, without considering geographic reclassifications, floors, and other adjustments made to the wage index under the IPPS. For a complete description of these IPPS wage index adjustments, we refer readers to the FY
2019 IPPS/LTCH PPS final rule 83 FR
41362 through 41390. Our wage index policy at 412.424a2, requires us to use the best Medicare data available to estimate costs per day, including an appropriate wage index to adjust for wage differences.
When the IPF PPS was implemented in the November 15, 2004 IPF PPS final rule, with an effective date of January 1, 2005, the pre-floor, pre-reclassified IPPS

VerDate Sep<11>2014

21:11 Aug 03, 2021

Jkt 253001

hospital wage index that was available at the time was the FY 2005 pre-floor, pre-reclassified IPPS hospital wage index. Historically, the IPF wage index for a given RY has used the pre-floor, pre-reclassified IPPS hospital wage index from the prior FY as its basis.
This has been due in part to the prefloor, pre-reclassified IPPS hospital wage index data that were available during the IPF rulemaking cycle, where an annual IPF notice or IPF final rule was usually published in early May.
This publication timeframe was relatively early compared to other Medicare payment rules because the IPF
PPS follows a RY, which was defined in the implementation of the IPF PPS as the 12-month period from July 1 to June 30 69 FR 66927. Therefore, the best available data at the time the IPF PPS
was implemented was the pre-floor, prereclassified IPPS hospital wage index from the prior FY for example, the RY
2006 IPF wage index was based on the FY 2005 pre-floor, pre-reclassified IPPS
hospital wage index.
In the RY 2012 IPF PPS final rule, we changed the reporting year timeframe for IPFs from a RY to the FY, which begins October 1 and ends September 30
76 FR 26434 through 26435. In that FY
2012 IPF PPS final rule, we continued our established policy of using the prefloor, pre-reclassified IPPS hospital wage index from the prior year that is, from FY 2011 as the basis for the FY
2012 IPF wage index. This policy of basing a wage index on the prior years pre-floor, pre-reclassified IPPS hospital wage index has been followed by other Medicare payment systems, such as hospice and inpatient rehabilitation facilities. By continuing with our established policy, we remained consistent with other Medicare payment systems.
In FY 2020, we finalized the IPF wage index methodology to align the IPF PPS
wage index with the same wage data timeframe used by the IPPS for FY 2020
and subsequent years. Specifically, we finalized to use the pre-floor, prereclassified IPPS hospital wage index from the FY concurrent with the IPF FY
as the basis for the IPF wage index. For example, the FY 2020 IPF wage index was based on the FY 2020 pre-floor, prereclassified IPPS hospital wage index rather than on the FY 2019 pre-floor, pre-reclassified IPPS hospital wage index.
We explained in the FY 2020
proposed rule 84 FR 16973, that using the concurrent pre-floor, pre-reclassified IPPS hospital wage index will result in the most up-to-date wage data being the basis for the IPF wage index. It will also result in more consistency and parity in
PO 00000

Frm 00010

Fmt 4701

Sfmt 4700

the wage index methodology used by other Medicare payment systems. The Medicare SNF PPS already used the concurrent IPPS hospital wage index data as the basis for the SNF PPS wage index. Thus, the wage adjusted Medicare payments of various provider types will be based upon wage index data from the same timeframe. CMS
proposed similar policies to use the concurrent pre-floor, pre-reclassified IPPS hospital wage index data in other Medicare payment systems, such as hospice and inpatient rehabilitation facilities. For FY 2022, we proposed to continue to use the concurrent pre-floor, pre-reclassified IPPS hospital wage index as the basis for the IPF wage index.
Comment: Several commenters expressed concerns with our proposal to continue using the concurrent pre-floor, pre-reclassified IPPS hospital wage index as the basis for the IPF wage index. Three commenters recommended CMS extend the transition for the reductions in payment for certain IPFs resulting from the wage index changes adopted in the FY 2021 IPF PPS final rule. Another commenter also recommended that CMS apply a nonbudget neutral 5 percent cap on decreases to a hospitals wage index value to help mitigate wide annual swings that are beyond a hospitals ability to control.
Response: We did not propose to modify the transition policy that was finalized in the FY 2021 IPF PPS final rule; therefore, we are not changing the previously adopted policy in this final rule. As we discussed in the FY 2021
IPF PPS final rule 85 FR 47058 through 47059, the transition policy caps the estimated reduction in an IPFs wage index to 5 percent in FY 2021, with no cap applied in FY 2022. We stated our belief that implementing updated wage index values along with the revised OMB delineations will result in wage index values being more representative of the actual costs of labor in a given area. As evidenced by the detailed economic analysis 85 FR 47065 through 47068, we estimated that implementing these wage index changes would have distributional effects, both positive and negative, among IPF providers. We continue to believe that applying the 5percent cap transition policy in year one provided an adequate safeguard against any significant payment reductions, has allowed for sufficient time to make operational changes for future FYs, and provided a reasonable balance between mitigating some short-term instability in IPF payments and improving the accuracy of the payment adjustment for differences in area wage levels.

E:FRFM04AUR5.SGM

04AUR5