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Federal Register / Vol. 86, No. 154 / Friday, August 13, 2021 / Rules and Regulations
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TABLE V.-ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED
EXPENDITURES UNDER THE IPPS FROM FY 2021 TO FY 2022
Category Annualized Monetized Transfers From Whom to Whom B. LTCHs As discussed in section I.J. of this Appendix, the impact analysis of the payment rates and factors presented in this final rule under the LTCH PPS is projected to result in an increase in estimated aggregate LTCH PPS payments in FY 2022 relative to FY 2021 of approximately $42 million based on the data for 363 LTCHs in our database that are subject to payment under the LTCH
PPS. Therefore, as required by OMB Circular
Transfers $2.293 billion Federal Government to IPPS Medicare Providers
A4 available at: https
obamawhitehouse.archives.gov/omb/
circulars_a004_a-4/ and https georgewbushwhitehouse.archives.gov/omb/circulars/
a004/a-4.html, in Table VI. of this Appendix, we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this final rule as they relate to the changes to the LTCH PPS. Table VI. of this Appendix provides our best estimate of the estimated
change in Medicare payments under the LTCH PPS as a result of the final payment rates and factors and other provisions presented in this final rule based on the data for the 363 LTCHs in our database. All expenditures are classified as transfers to Medicare providers that is, LTCHs.
As shown in Table VI. of this Appendix, the net cost to the Federal Government associated with the final policies for LTCHs in this final rule are estimated at $42 million.

TABLE VI.-ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED
EXPENDITURES FROM THE FY 2021 LTCH PPS TO THE FY 2022 LTCH PPS
Category Annualized Monetized Transfers From Whom to Whom III. Regulatory Flexibility Act RFA
Analysis The RFA requires agencies to analyze options for regulatory relief of small entities.
For purposes of the RFA, small entities include small businesses, nonprofit
Transfers $42 million Federal Government to L TCH Medicare Providers
organizations, and small government jurisdictions. We estimate that most hospitals and most other providers and suppliers are small entities as that term is used in the RFA.
The great majority of hospitals and most other health care providers and suppliers are small entities, either by being nonprofit
organizations or by meeting the SBA
definition of a small business. Table VII.
details the size standards for those industries that may be affected by this rule, though we expect that General Medical and Surgical Hospitals would be most affected.

TABLE VII.--SIZE STANDARDS BY AFFECTED INDUSTRY

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RFA analysis serves as the Final Regulatory Flexibility Analysis. In Table I.Impact Analysis of Changes to the IPPS for Operating Costs for FY 2022, we display the expected impact on the 3,198 IPPS hospitals. Column 8 indicates the total expected impact of all changes to the IPPS for various classifications of hospitals. For instance, we detail the expected impact by bed size for urban and rural hospitals. Under our final policies, we estimate that the 634 urban hospitals with a bed size of 0 to 99 would have an impact of a 2.7 percent increase in their IPPS
payments, while the 311 rural hospitals with a bed size of 0 to 49 would have an impact of a 4.3 percent increase in their IPPS
payments. Overall, the impact on hospitals by bed size ranges from 2.4 percent to 4.3
percent, primarily due to the hospital rate update, as discussed in section I.G. of this Appendix. We note that for some hospitals, these figures may represent the total expected
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impact on their inpatient hospital revenue;
for other hospitals, this represents only a portion of the total expected impact, as much of their revenue comes from non-Medicare cases.
In Table IV. Impact of Payment Rate and Policy Changes to LTCH PPS Payments and Policy Changes to LTCH PPS Payments for LTCH PPS Standard Payment Rate Cases for FY 2022 Estimated FY 2022 Payments Compared to Estimated FY 2021 Payments we display the expected impact on the 363
LTCH PPS hospitals. Column 8 indicates the total expected impact of all changes to the LTCH PPS for various classifications of LTCH
PPS hospitals. Under our final policies, we estimate that hospitals with a bed size of 0
to 24 would have an impact of 0.6 percent, while hospitals with a bed size of 25 to 49
would have an impact of 1.0 percent. Overall, the impact on hospitals by bed size ranges from 0.6 to 1.0 percent, primarily due to the
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For purposes of the RFA, all hospitals and other providers and suppliers are considered to be small entities. Because all hospitals are considered to be small entities for purposes of the RFA, the hospital impacts described in this final rule are impacts on small entities.
Individuals and States are not included in the definition of a small entity. MACs are not considered to be small entities because they do not meet the SBA definition of a small business.
HHSs practice in interpreting the RFAs reference to a significant economic impact on a substantial number of small entities is to consider effects economically significant if greater than 5 percent of small providers reach a threshold of 3 to 5 percent or more of total revenue or total costs. We believe that the provisions of this final rule relating to IPPS hospitals will have an economically significant impact on small entities as explained in this Appendix. Therefore, this
Size Standard $ 41.5
$ 41.5
$ 41.5

ER13AU21.357

NAICS Industry Description General Medical and Surgical Hospitals Psychiatric and Substance Abuse Hospitals Specialty except Psychiatric and Substance Abuse Hospitals
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NAICS Code 622110
622210
622310