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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations New Enciland Mid-Atlantic South Atlantic East North Central East South Central West North Central West South Central Mountain Pacific
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106
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243
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155
109
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103
131

0.2
0.2
0.1
0.1
0.1
0.2
0.1
0.1
0.2

-1.2
-2.0
-0.7
-0.7
-0.7
-1.4
-0.5
-0.7
-1.4

-0.4
-0.2
0.6
-0.2
-0.5
0.1
-0.2
0.3
0.4

-0.4
-0.2
0.6
-0.2
-0.5
0.1
-0.3
0.3
0.4

1.8
2.0
2.7
1.9
1.6
2.3
1.8
2.4
2.6

42675
0.3
-0.2
1.9
1.0
0.7
0.7
1.3
1.6
1.0

BILLING CODE 412001C

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3. Impact Results Table 18 displays the results of our analysis. The table groups IPFs into the categories listed here based on characteristics provided in the Provider of Services file, the IPF PSF, and cost report data from the Healthcare Cost Report Information System:
Facility Type.
Location.
Teaching Status Adjustment.
Census Region.
Size.
The top row of the table shows the overall impact on the 1,519 IPFs included in the analysis for FY 2019
claims or the 1,534 IPFs included in the analysis for FY 2020 claims. In column 2, we present the number of facilities of each type that had information available in the PSF and also had claims in the MedPAR dataset for FY 2019 or FY
2020. The number of providers in each category therefore differs slightly between the two years.
In column 3, we present the effects of the update to the outlier fixed dollar loss threshold amount. Based on the FY
2019 claims, we would estimate that IPF
outlier payments as a percentage of total IPF payments are 1.9 percent in FY
2021. Alternatively, based on the FY
2020 claims, we would estimate that IPF

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outlier payments as a percentage of total IPF payments are 3.1 percent in FY
2021.
Thus, we are finalizing our proposal to adjust the outlier threshold amount in this final rule to set total estimated outlier payments equal to 2.0 percent of total payments in FY 2022. Based on the FY 2019 claims, the estimated change in total IPF payments for FY 2022 would include an approximate 0.1 percent increase in payments because we would expect the outlier portion of total payments to increase from approximately 1.9 percent to 2.0
percent. Alternatively, based on the FY
2020 claims, the estimated change in total IPF payments for FY 2022 would include an approximate 1.1 percent decrease in payments because we would expect the outlier portion of total payments to decrease from approximately 3.1 percent to 2.0
percent.
The overall impact of the estimated increase or decrease to payments due to updating the outlier fixed dollar loss threshold as shown in column 3 of Table 18, across all hospital groups, is 0.1 percent based on the FY 2019
claims, or 1.1 percent based on the FY
2020 claims. Based on the FY 2019
claims, the largest increase in payments due to this change is estimated to be 0.4

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percent for teaching IPFs with more than 30 percent interns and residents to beds. Among teaching IPFs, this same provider facility type would experience the largest estimated decrease in payments if we were to instead increase the outlier fixed dollar loss threshold based on the FY 2020 claims distribution.
In column 4, we present the effects of the budget-neutral update to the IPF
wage index, the Labor-Related Share LRS, and the final updated COLA
factors discussed in section III.D.3. This represents the effect of using the concurrent hospital wage data as discussed in section III.D.1.a of this final rule. That is, the impact represented in this column reflects the final updated COLA factors and the update from the FY 2021 IPF wage index to the final FY 2022 IPF wage index, which includes basing the FY
2022 IPF wage index on the FY 2022
pre-floor, pre-reclassified IPPS hospital wage index data and updating the LRS
from 77.3 percent in FY 2021 to 77.2
percent in FY 2022. We note that there is no projected change in aggregate payments to IPFs, as indicated in the first row of column 4; however, there will be distributional effects among different categories of IPFs. We also note that when comparing the results using
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By Bed Size:
Psychiatric Hospitals Beds: 0-24
-0.5
83
88
0.1
0.1
0.0
2.1
1.5
-0.2
-0.3
-0.3
1.8
1.5
Beds: 25-49
79
83
0.1
-0.1
Beds: 50-75
84
88
0.0
0.1
0.2
2.1
2.2
0.1
-0.4
0.1
0.1
2.2
1.7
Beds: 76 +
295
300
Psychiatric Units Beds: 0-24
531
0.2
-1.2
0.0
0.0
2.2
0.7
536
Beds: 25-49
258
259
0.2
-1.3
0.0
0.0
2.2
0.7
-2.0
-0.3
-0.3
-0.3
Beds: 50-75
114
114
0.2
2.0
-2.5
-0.5
Beds: 76 +
70
71
0.3
0.0
0.0
2.3
1 This column includes the impact of the updates in columns 3 and 4 in Table 18 above, and of the final IPF market basket increase factor for FY 2022 2.7 percent, reduced by 0.7 percentage point for the productivity adjustment as required by section 1886s2Ai of the Act. Note, the products of these impacts may be different from the percentage changes shown here due to rounding effects.