Quiero saber acerca de...

jbell on DSKJLSW7X2PROD with RULES2

45614

Federal Register / Vol. 86, No. 154 / Friday, August 13, 2021 / Rules and Regulations
hospitals that are not meaningful EHR users increases to 6623 percent for FY 2023, and, for FY 2024 and subsequent fiscal years, to 100 percent. In the FY 2019 IPPS/LTCH PPS
final rule, we finalized the payment reductions 83 FR 41674.
Based on IGIs fourth quarter 2020 forecast of the proposed 2018-based IPPS market basket update with historical data through third quarter 2020, in the FY 2022 IPPS/
LTCH PPS proposed rule, in accordance with section 1886b3B of the Act, as previously discussed, for Puerto Rico hospitals, we proposed a market basket update of 2.5
percent and a productivity adjustment of 0.2
percent. Therefore, for FY 2022, depending on whether a Puerto Rico hospital is a meaningful EHR user, we stated that there are two possible applicable percentage increases that can be applied to the standardized amount. Based on these data, we determined the following proposed applicable percentage increases to the standardized amount for FY
2022 for Puerto Rico hospitals:
For a Puerto Rico hospital that is a meaningful EHR user, we proposed an applicable percentage increase to the FY
2022 operating standardized amount of 2.3
percent that is, the FY 2022 estimate of the proposed market basket rate-of-increase of 2.5 percent less an adjustment of 0.2
percentage point for the productivity adjustment.
For a Puerto Rico hospital that is not a meaningful EHR user, we proposed an applicable percentage increase to the operating standardized amount of 1.675
percent that is, the FY 2022 estimate of the proposed market basket rate-of-increase of 2.5 percent, less an adjustment of 0.625
percentage point the proposed market basket rate-of-increase of 2.5 percent 0.75/3 for failure to be a meaningful EHR user, less an adjustment of 0.2 percentage point for the productivity adjustment.
As noted previously, we proposed that if more recent data subsequently become available, we would use such data, if appropriate, to determine the FY 2022 market basket update and the productivity adjustment for the FY 2022 IPPS/LTCH PPS
final rule.
As discussed in section V.A.1. of the preamble of this final rule, based on more recent data available for this FY 2022 IPPS/
LTCH PPS final rule that is, IGIs second quarter 2021 forecast of the 2018-based IPPS
market basket rate-of-increase with historical data through the first quarter of 2021, we estimate that the FY 2022 market basket update used to determine the applicable percentage increase for the IPPS is 2.7
percent and a productivity adjustment of 0.7
percent. Therefore, in accordance with section 1886b3B of the Act, for this final rule, for Puerto Rico hospitals the more recent update of the market basket update is 2.7 percent and a productivity adjustment of 0.7 percent. For FY 2022, depending on whether a Puerto Rico hospital is a meaningful EHR user, there are two possible applicable percentage increases that can be applied to the standardized amount. Based on these data, we determined the following applicable percentage increases to the standardized amount for FY 2022 for Puerto Rico hospitals:

VerDate Sep<11>2014

02:06 Aug 13, 2021

Jkt 253001

For a Puerto Rico hospital that is a meaningful EHR user, an applicable percentage increase to the FY 2022 operating standardized amount of 2.0 percent that is, the FY 2022 estimate of the market basket rate-of-increase of 2.7 percent less an adjustment of 0.7 percentage point for the productivity adjustment.
For a Puerto Rico hospital that is not a meaningful EHR user, an applicable percentage increase to the operating standardized amount of 1.325 percent that is, the FY 2022 estimate of the market basket rate-of-increase of 2.7 percent, less an adjustment of 0.675 percentage point the market basket rate of-increase of 2.7 percent 0.75/3 for failure to be a meaningful EHR
user, less an adjustment of 0.7 percentage point for the productivity adjustment.
D. Update for Hospitals Excluded From the IPPS for FY 2022
Section 1886b3Bii of the Act is used for purposes of determining the percentage increase in the rate-of-increase limits for childrens hospitals, cancer hospitals, and hospitals located outside the 50 States, the District of Columbia, and Puerto Rico that is, short-term acute care hospitals located in the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and America Samoa.
Section 1886b3Bii of the Act sets the percentage increase in the rate-of-increase limits equal to the market basket percentage increase. In accordance with 403.752a of the regulations, RNHCIs are paid under the provisions of 413.40, which also use section 1886b3Bii of the Act to update the percentage increase in the rate-of-increase limits.
Currently, childrens hospitals, PPSexcluded cancer hospitals, RNHCIs, and short-term acute care hospitals located in the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are among the remaining types of hospitals still paid under the reasonable cost methodology, subject to the rate-of-increase limits. In addition, in accordance with 412.526c3
of the regulations, extended neoplastic disease care hospitals described in 412.22i of the regulations also are subject to the rate-of-increase limits. As discussed in section VI. of the preamble of this final rule, we are finalizing to use the percentage increase in the 2018-based IPPS operating market basket to update the target amounts for childrens hospitals, PPS-excluded cancer hospitals, RNHCIs, short-term acute care hospitals located in the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa, and extended neoplastic disease care hospitals for FY 2022 and subsequent fiscal years. Accordingly, for FY
2022, the rate-of-increase percentage to be applied to the target amount for these childrens hospitals, cancer hospitals, RNHCIs, extended neoplastic disease care hospitals, and short-term acute care hospitals located in the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa is the FY 2022 percentage increase in the 2018-based IPPS operating market basket.
For this final rule, the current estimate of the IPPS operating market basket percentage increase for FY 2022 is 2.7 percent.

PO 00000

Frm 00842

Fmt 4701

Sfmt 4700

E. Update for LTCHs for FY 2022
Section 123 of Public Law 106113, as amended by section 307b of Public Law 106554 and codified at section 1886m1
of the Act, provides the statutory authority for updating payment rates under the LTCH
PPS.
As discussed in section V.A. of the Addendum to this final rule, we are establishing an update to the LTCH PPS
standard Federal payment rate for FY 2022 of 1.9 percent, consistent with section 1886m3 of the Act which provides that any annual update be reduced by the productivity adjustment described in section 1886b3BxiII of the Act. Furthermore, in accordance with the LTCHQR Program under section 1886m5 of the Act, we are reducing the annual update to the LTCH PPS
standard Federal rate by 2.0 percentage points for failure of a LTCH to submit the required quality data. Accordingly, we are establishing an update factor of 1.019 in determining the LTCH PPS standard Federal rate for FY 2022. For LTCHs that fail to submit quality data for FY 2022, we are establishing an annual update to the LTCH
PPS standard Federal rate of 0.1 percent that is, the annual update for FY 2022 of 1.9
percent less 2.0 percentage points for failure to submit the required quality data in accordance with section 1886m5C of the Act and our rules by applying a update factor of 0.999 in determining the LTCH PPS
standard Federal rate for FY 2022. We note that, as discussed in section VIII.C. of the preamble of this final rule, the update to the LTCH PPS standard Federal payment rate of 1.9 percent for FY 2022 does not reflect any budget neutrality factors.
III. Secretarys Recommendations MedPAC is recommending an inpatient hospital update of 2.0 percent. MedPACs rationale for this update recommendation is described in more detail in this section. As previously stated, 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. Consistent with current law, depending on whether a hospital submits quality data and is a meaningful EHR user, we are recommending the four applicable percentage increases to the standardized amount listed in the table under section II.
of this Appendix B. We are recommending that the same applicable percentage increases apply to SCHs and MDHs.
In addition to making a recommendation for IPPS hospitals, in accordance with section 1886e4A of the Act, we are recommending update factors for certain other types of hospitals excluded from the IPPS. Consistent with our policies for these facilities, we are recommending an update to the target amounts for childrens hospitals, cancer hospitals, RNHCIs, short-term acute care hospitals located in the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa and extended neoplastic disease care hospitals of 2.7
percent.

E:FRFM13AUR2.SGM

13AUR2