Quiero saber acerca de...

45612

Federal Register / Vol. 86, No. 154 / Friday, August 13, 2021 / Rules and Regulations
jbell on DSKJLSW7X2PROD with RULES2

1.9 percent annual update to the LTCH PPS
standard Federal payment rate for FY 2022
and the projected 0.8 percent decrease in high cost outlier payments as a percentage of total LTCH PPS standard Federal payment rate payments, as discussed in section I.J. of this Appendix.
This final rule contains a range of policies as summarized in section A. It provides descriptions of the statutory provisions that are addressed, identifies the policies, and presents rationales for our decisions and, where relevant, alternatives that were considered. We note that section 1886b3B of the Act sets the requirements for the FY 2022 applicable percentage increase. Therefore, consistent with the statute, the applicable percentage increase for FY 2022 is 2.0 percent, provided the hospital submits quality data and is a meaningful EHR
user consistent with these statutory requirements.
Under section 1886m of the Act, the annual update to the LTCH PPS is equal to the estimated LTCH market basket increase reduced by the productivity adjustment.
Therefore, consistent with the statute, the applicable percentage increase for FY 2022 is 1.9 percent that is, the most recent estimate of the LTCH PPS market basket increase of 2.6 percent less the productivity adjustment of 0.7 percentage point, provided the hospital submits quality reporting data under the LTCH Quality Reporting Program. The majority of the LTCH PPS hospitals included in the impact analysis shown 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 on average are expected to see increases in the range of 0.9 percent, primarily due to the 1.9 percent annual update to the LTCH PPS standard Federal payment rate for FY 2022 and the projected 0.8 percent decrease in high cost outlier payments as a percentage of total LTCH PPS standard Federal payment rate payments, as discussed in section I.J. of this Appendix.
This final rule contains a range of policies.
It provides descriptions of the statutory provisions that are addressed, identifies the policies, and presents rationales for our decisions and, where relevant, alternatives that were considered. The analyses discussed in this Appendix and throughout the preamble of this final rule constitutes our regulatory flexibility analysis. We solicited public comments on our estimates and analysis of the impact of our policies on small entities. We received on no public comments on those estimates and analysis.
IV. Impact on Small Rural Hospitals Section 1102b of the Act requires us to prepare a regulatory impact analysis for any proposed or final rule that may have a significant impact on the operations of a substantial number of small rural hospitals.
This analysis must conform to the provisions of section 604 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102b of the Act, we define a small rural hospital as
VerDate Sep<11>2014

02:06 Aug 13, 2021

Jkt 253001

a hospital that is located outside of an urban area and has fewer than 100 beds. Section 601g of the Social Security Amendments of 1983 Pub. L. 9821 designated hospitals in certain New England counties as belonging to the adjacent urban area. Thus, for purposes of the IPPS and the LTCH PPS, we continue to classify these hospitals as urban hospitals.
As shown in Table I. in section I.G. of this Appendix, rural IPPS hospitals with 049
beds 311 hospitals and 5099 beds 253
hospitals are expected to experience an increase in payments from FY 2021 to FY
2022 of 4.3 percent and 2.4 percent, respectively, primarily driven by the hospital rate update, as discussed in section I.G of this Appendix. We refer readers to Table I. in section I.G. of this Appendix for additional information on the quantitative effects of the policy changes under the IPPS for operating costs.
All rural LTCHs 19 hospitals shown in Table IV. in section I.J. of this Appendix have less than 100 beds. These hospitals are expected to experience an increase in payments from FY 2021 to FY 2022 of 1.2
percent, primarily due to the 1.9 percent annual update to the LTCH PPS standard Federal payment rate for FY 2022 and the projected 0.8 percent decrease in high cost outlier payments as a percentage of total LTCH PPS standard Federal payment rate payments, as discussed in section I.J. of this Appendix.
V. Unfunded Mandates Reform Act Analysis Section 202 of the Unfunded Mandates Reform Act of 1995 Pub. L. 1044 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2021, that threshold level is approximately $158 million. This final rule would not mandate any requirements that meet the threshold for State, local, or tribal governments, nor would it affect private sector costs.
VI. Executive Order 13175
Executive Order 13175 directs agencies to consult with Tribal officials prior to the formal promulgation of regulations having tribal implications. Section 1880a of the Act states that a hospital of the Indian Health Service, whether operated by such Service or by an Indian tribe or tribal organization, is eligible for Medicare payments so long as it meets all of the conditions and requirements for such payments which are applicable generally to hospitals. Consistent with section 1880a of the Act, this final rule contains general provisions also applicable to hospitals and facilities operated by the Indian Health Service or Tribes or Tribal organizations under the Indian SelfDetermination and Education Assistance Act.
As discussed in section V.E.4. of the preamble of this final rule, we remain committed to working with stakeholders to determine the methodology for determining uncompensated care payments to IHS and Tribal hospitals. Consistent with Executive Order 13175, we also continue to engage in consultation with Tribal officials on this issue. We intend to use input received from
PO 00000

Frm 00840

Fmt 4701

Sfmt 4700

these consultations with Tribal officials, as well as the comments on the proposed rule, to inform future rulemaking.
VII. Executive Order 12866
In accordance with the provisions of Executive Order 12866, the Office of Management and Budget reviewed this final rule.

Appendix B: Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services I. Background Section 1886e4A of the Act requires that the Secretary, taking into consideration the recommendations of MedPAC, recommend update factors for inpatient hospital services for each fiscal year that take into account the amounts necessary for the efficient and effective delivery of medically appropriate and necessary care of high quality. Under section 1886e5 of the Act, we are required to publish update factors recommended by the Secretary in the proposed and final IPPS rules. Accordingly, this Appendix provides the recommendations for the update factors for the IPPS national standardized amount, the hospital-specific rate for SCHs and MDHs, and the rate-of-increase limits for certain hospitals excluded from the IPPS, as well as LTCHs. In prior years, we made a recommendation in the IPPS proposed rule and final rule for the update factors for the payment rates for IRFs and IPFs. However, for FY 2022, consistent with our approach for FY 2021, we are including the Secretarys recommendation for the update factors for IRFs and IPFs in separate Federal Register documents at the time that we announce the annual updates for IRFs and IPFs. We also discuss our response to MedPACs recommended update factors for inpatient hospital services.
II. Inpatient Hospital Update for FY 2022
A. FY 2022 Inpatient Hospital Update As discussed in section V.A. of the preamble to this final rule, for FY 2022, consistent with section 1886b3B of the Act, as amended by sections 3401a and 10319a of the Affordable Care Act, we are setting the applicable percentage increase by applying the following adjustments in the following sequence. Specifically, the applicable percentage increase under the IPPS is equal to the rate-of-increase in the hospital market basket for IPPS hospitals in all areas, subject to a reduction of one-quarter of the applicable percentage increase prior to the application of other statutory adjustments; also referred to as the market basket update or rate-of-increase with no adjustments for hospitals that fail to submit quality information under rules established by the Secretary in accordance with section 1886b3Bviii of the Act and a reduction of three-quarters of the applicable percentage increase prior to the application of other statutory adjustments; also referred to as the market basket update or rate-of-increase with no adjustments for hospitals not considered to be meaningful electronic
E:FRFM13AUR2.SGM

13AUR2