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Federal Register / Vol. 86, No. 154 / Friday, August 13, 2021 / Rules and Regulations
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to define digital quality measures dQMs for the LTCH QRP; the potential use of Fast Healthcare Interoperability Resources FHIR
for dQMs within the LTCH QRP; and input on CMS continued efforts to close the health equity gap.
The CDC will account for the burden associated with the COVID19 Vaccination Coverage among HCP measure collection under OMB control number 09201317
expiration January 31, 2024. However, the CDC currently has a PRA waiver for the collection and reporting of vaccination data under section 321 of the National Childhood Vaccine Injury Act of 1986 Pub. L. 99660, enacted on November 14, 1986 NCVIA.1401
We refer readers to section XII.B.8. of this final rule, where CMS has provided an estimate of the burden and cost to LTCHs, and note that the CDC will include it in a revised information collection request for 09201317.
N. Effects of Requirements Regarding the Medicare Promoting Interoperability Program In section IX.F.3.b. of the preamble of this final rule, we are finalizing the following proposed changes for CY 2022 with eligible hospitals and CAHs that attest to CMS under the Medicare Promoting Interoperability Program: 1 To maintain the Electronic Prescribing Objectives Query of PDMP
measure as optional while increasing its available bonus from five points to 10 points for the EHR reporting period in CY 2022; 2
to add a new Health Information Exchange HIE Bi-Directional Exchange measure as a yes/no attestation to the HIE objective as an optional alternative to the two existing measures, beginning with the EHR reporting period in CY 2022; 3 to require reporting on four of the existing Public Health and Clinical Data Exchange Objective measures Syndromic Surveillance Reporting, Immunization Registry Reporting, Electronic Case Reporting, and Electronic Reportable Laboratory Result Reporting; 4 to add a new measure to the Protect Patient Health Information objective that requires eligible hospitals and CAHs to attest to having completed an annual assessment of the SAFER Guides, beginning with the EHR
reporting period in CY 2022; 5 to remove attestation statements 2 and 3 from the Promoting Interoperability Programs prevention of information blocking requirement; and 6 to increase the minimum required score for the objectives and measures from 50 points to 60 points out of 100 points in order to be considered a meaningful EHR user. We are amending our regulation text as necessary to incorporate these changes.
In section IX.F.3.b. of the preamble of this final rule, we are finalizing the following proposed changes for CY 2024 with eligible hospitals and CAHs that attest to CMS under the Medicare Promoting Interoperability Program: 1 An EHR reporting period of a minimum of any continuous 180-day period 1401 Section 321 of the NCVIA provides the PRA
waiver for activities that come under the NCVIA, including those in the NCVIA at section 2102 of the Public Health Service Act 42 U.S.C. 300aa2.
Section 321 is not codified in the U.S. Code, but can be found in a note at 42 U.S.C. 300aa1.

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in CY 2024 for new and returning participants eligible hospitals and CAHs;
and 2 to remove three eCQMs from the Medicare Promoting Interoperability Programs eCQM measure set beginning with the reporting period in CY 2024, which is in alignment with the proposals being finalized under the Hospital IQR Program. We are not finalizing our proposal to remove Anticoagulation Therapy for Atrial Fibrillation/Flutter eCQM STK03 in alignment with the Hospital IQR Program;
however, this retention will not change impacts to hospitals. Similar to the FY 2019
IPPS/LTCH PPS final rule regarding removal of eCQM measures, while there is no change in information collection burden related to those finalized provisions, we believe that costs are multifaceted and include not only the burden associated with reporting but also the costs associated with implementing and maintaining program measures in hospitals EHR systems for all of the eCQMs available for use in the Medicare Promoting Interoperability and Hospital IQR Programs 83 FR 41771. We are amending our regulation text as necessary to incorporate these changes.
As described in section IX.F.11.4. of the preamble of this final rule, as proposed, we are finalizing an update to certification requirements requiring the use of the 2015
Edition Cures Update for eCQMs in alignment with the finalized proposal for the Hospital IQR Program, beginning with the FY
2025 payment determination. We expect this policy to have no impact on information collection burden for the Medicare Promoting Interoperability Program because this policy does not require hospitals to submit new data to CMS. Because the Medicare Promoting Interoperability Program previously finalized a requirement that hospitals use the 2015
Edition Cures Update 85 FR 84818 through 84825, we do not anticipate any additional costs as a result of this finalized policy.
For the EHR reporting period in CY 2022, the provisions summarized here are mainly extensions from or continuations of existing policies from the FY 2021 IPPS/LTCH PPS
final rule 85 FR 58966 through 58977 and finalized proposals included in the CY 2021
PFS final rule 85 FR 84825 through 84828.
However, due to an update of the hospital staff professional who most likely conducts the reporting for the Medicare Promoting Interoperability Program, we have updated the Bureau of Labor Statistics wage rate. Such changes will result in an estimated total burden cost of $879,450 for CY 2022 a net decrease of $607,893 from CY 2021. While in this final rule, we are finalizing proposals that influence programmatic policies in CY
2023 and CY 2024, we do not believe they would attribute to a rise in burden hours, meaning that both prospective years would maintain the same estimated total burden cost of $879,450. We refer readers to section XII.B. of the preamble of this final rule information collection requirements for a detailed discussion of the calculations estimating the changes to the information collection burden for submitting data to the Medicare Promoting Interoperability Program.
We received no comments on these effects.

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O. Alternatives Considered This final rule contains a range of policies.
It also provides descriptions of the statutory provisions that are addressed, identifies the finalized policies, and presents rationales for our decisions and, where relevant, alternatives that were considered.
1. Use of FY 2020 or FY 2019 Data in the FY
2022 IPPS and LTCH PPS Ratesetting In the FY 2022 IPPS and LTCH PPS
proposed rule 86 FR 25086 through 25090
we explained that for the IPPS and LTCH
PPS ratesetting, our longstanding goal is to use the best available data. We discussed our analysis of the best available data for use in the development of the FY 2022 IPPS/LTCH
PPS proposed rule given the potential impact of the PHE for COVID19. We proposed to use FY 2019 data, such as the FY 2019
MedPAR file, for the FY 2022 ratesetting for circumstances where the FY 2020 data is significantly impacted by the COVID19
PHE, primarily in that the utilization of inpatient services reflect generally markedly different utilization for certain types of services in FY 2020 than would have been expected in the absence of the PHE.
Alternatively, we considered whether we should use the FY 2020 data instead of the FY 2019 data for FY 2022 ratesetting purposes. The FY 2020 data is what CMS
would ordinarily use for purposes of FY 2022
ratesetting. Public comments were largely supportive of CMS use of FY 2019 data. Most commenters agreed that, to the extent possible, CMS should use the best available data and that the PHE for COVID19
impacted FY 2020 claims data in a way that may make it less accurate and appropriate for FY 2022 ratesetting purposes. As discussed in section II.F. of the preamble of this final rule, and following our review of public comments, we are finalizing use of the FY
2019 data for the FY 2022 IPPS and LTCH
PPS ratesetting for circumstances where the FY 2020 data is significantly impacted by the COVID19 PHE. For example, we are finalizing our proposal to use the FY 2019
MedPAR claims data for purposes where we ordinarily would have used the FY 2020
MedPAR claims data, such as in our analysis of changes to MSDRG classifications as discussed in greater detail in section II.D. of the preamble of this final rule. Similarly, we are finalizing the use of cost report data from the FY 2018 HCRIS file for purposes where we ordinarily would have used the FY 2019
HCRIS file, such as in determining the final FY 2022 IPPS MSDRG as discussed in greater detail in section II.D. of the preamble of this final rule and finalized FY 2022 MS
LTCDRG relative weights as discussed in greater detail section VI.B. of the preamble of this final rule.
2. Market-Based MSDRG Relative Weight Policy In the FY 2021 IPPS/LTCH PPS final rule, we finalized a requirement for a hospital to report on the Medicare cost report the median payer-specific negotiated charge that the hospital has negotiated with all of its MA
organization payers, by MSDRG, for cost reporting periods ending on or after January 1, 2021 85 FR 58873 through 58892; this data collection requirement was specified in
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