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Federal Register / Vol. 86, No. 154 / Friday, August 13, 2021 / Rules and Regulations of the Act, we proposed to base the proposed FY 2022 market basket update used to determine the applicable percentage increase for the IPPS on IGIs fourth quarter 2020
forecast of the proposed 2018-based IPPS
market basket rate-of-increase with historical data through third quarter 2020, which was estimated to be 2.5 percent. In accordance with section 1886b3B of the Act, as amended by section 3401a of the Affordable Care Act, in section IV.B. of the preamble of the FY 2022 IPPS/LTCH PPS proposed rule, based on IGIs fourth quarter 2020 forecast, we proposed a productivity adjustment of 0.2
percentage point for FY 2022. We also proposed that if more recent data subsequently became available, we would use such data, if appropriate, to determine the FY 2022 market basket update and productivity adjustment for the final rule.
In the FY 2022 IPPS/LTCH PPS proposed rule, based on IGIs fourth quarter 2020
forecast of the 2018-based IPPS market basket and the productivity adjustment, depending on whether a hospital submits quality data under the rules established in accordance with section 1886b3Bviii of the Act
FY2022
Market Basket Rate-of-Increase Adjustment for Failure to Submit Quality Data under Section 1886b3Bviii of the Act Adjustment for Failure to be a Meaningful EHR
User under Section 1886b3Bix of the Act Productivity Adjustment under Section 1886b3Bxi of the Act Applicable Percentage Increase Applied to Standardized Amount
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B. Update for SCHs and MDHs for FY 2022
Section 1886b3Biv of the Act provides that the FY 2022 applicable percentage increase in the hospital-specific rate for SCHs and MDHs equals the applicable percentage increase set forth in section 1886b3Bi of the Act that is, the same update factor as for all other hospitals subject to the IPPS. Under current law, the MDH program is effective for discharges through September 30, 2022, as discussed in the FY 2019 IPPS/LTCH PPS final rule 83 FR
41429 through 41430.
As previously stated, the update to the hospital specific rate for SCHs and MDHs is subject to section 1886b3Bi of the Act, as amended by sections 3401a and 10319a of the Affordable Care Act. Accordingly, depending on whether a hospital submits quality data and is a meaningful EHR user, we are establishing the same four possible applicable percentage increases in the
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Hospital Submitted Quality Data and is a Meaningful EHR User 2.7

Hospital Submitted Quality Data and is NOTa Meaningful EHR User 2.7

Hospital Did NOT
Submit Quality Data and is a Meaningful EHR User 2.7

Hospital Did NOT
Submit Quality Data and is NOTa Meaningful EHR User 2.7

0

0

-0.675

-0.675

0

-2.025

0

-2.025

-0.7

-0.7

-0.7

-0.7

2.0

-0.025

1.325

-0.7

previous table for the hospital-specific rate applicable to SCHs and MDHs.
C. FY 2022 Puerto Rico Hospital Update Because Puerto Rico hospitals are no longer paid with a Puerto Rico-specific standardized amount under the amendments to section 1886d9E of the Act, there is no longer a need for us to make an update to the Puerto Rico standardized amount. Hospitals in Puerto Rico are now paid 100 percent of the national standardized amount and, therefore, are subject to the same update to the national standardized amount discussed under section V.A.1. of the preamble of this final rule.
In addition, as discussed in section V.A.2.
of the preamble of this final rule, section 602
of Public Law 114113 amended section 1886n6B of the Act to specify that subsection d Puerto Rico hospitals are eligible for incentive payments for the meaningful use of certified EHR technology,
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hereafter referred to as a hospital that submits quality data and is a meaningful EHR user under section 1886b3Bix of the Act hereafter referred to as a hospital that is a meaningful EHR user, we presented 4 possible applicable percentage increases that could be applied to the standardized amount.
In accordance with section 1886b3B of the Act, as amended by section 3401a of the Affordable Care Act, we are establishing the applicable percentages increase for the FY
2022 updates based on IGIs second quarter 2021 forecast of the 2018-based IPPS market basket of 2.7 percent and the productivity adjustment of 0.7 percentage point, as discussed in section V.A. of the preamble of this final rule, depending on whether a hospital submits quality data under the rules established in accordance with section 1886b3Bviii of the Act and is a meaningful EHR user under section 1886b3Bix of the Act, as shown in the table in this section.

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effective beginning FY 2016. In addition, section 1886n6B of the Act was amended to specify that the adjustments to the applicable percentage increase under section 1886b3Bix of the Act apply to subsection d Puerto Rico hospitals that are not meaningful EHR users, effective beginning FY 2022.
Accordingly, for FY 2022, section 1886b3Bix of the Act in conjunction with section 602d of Public Law 114113
requires that any subsection d Puerto Rico hospital that is not a meaningful EHR user as defined in section 1886n3 of the Act and not subject to an exception under section 1886b3Bix of the Act will have threequarters of the applicable percentage increase prior to the application of other statutory adjustments, or three-quarters of the applicable market basket rate-of-increase, reduced by 3313 percent. The reduction to three-quarters of the applicable percentage increase for subsection d Puerto Rico
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health record EHR users in accordance with section 1886b3Bix of the Act, and then subject to an adjustment based on changes in economy-wide productivity the productivity adjustment. Section 1886b3Bxi of the Act, as added by section 3401a of the Affordable Care Act, states that application of the productivity adjustment may result in the applicable percentage increase being less than zero. We note that section 1886b3Bxii of the Act required an additional reduction each year only for FYs 2010 through 2019.
We note that, in compliance with section 404 of the MMA, in the FY 2018 IPPS/LTCH
PPS final rule 82 FR 38158 through 38175, we replaced the FY 2010-based IPPS
operating and capital market baskets with the rebased and revised 2014-based IPPS
operating and capital market baskets effective beginning in FY 2018. In this final rule, we are replacing the 2014-based IPPS operating and capital market baskets with the rebased and revised 2018-based IPPS operating and capital market baskets beginning in FY 2022.
In the FY 2022 IPPS/LTCH PPS proposed rule, in accordance with section 1886b3B