Je veux savoir à propos de…

42622

Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
composition of the IPPS market basket nonlabor-related share. The current composition of the CPI for All Items for all of the respective areas is approximately 40 percent commodities and 60 percent services. However, the IPPS nonlabor-related share is comprised of a different mix of commodities and services. Therefore, we are finalizing our proposal to create reweighted indexes for Urban Alaska, Urban Hawaii, and the average U.S. city using the respective CPI commodities index and CPI services index and proposed shares of 57 percent commodities/43 percent. We created reweighted indexes using BLS data for 2009 through 2020the most recent data available at the time of this final rulemaking. In the FY 2018 IPPS/LTCH
PPS final rule 82 FR 38530, we created
reweighted indexes based on the 2014based IPPS market basket which was adopted for the FY 2018 IPPS update and BLS data for 2009 through 2016 the most recent BLS data at the time of the FY 2018 IPPS/LTCH PPS rulemaking, and we updated the IPF PPS COLA
factors accordingly for FY 2018.
We continue to believe this methodology is appropriate because we continue to make a COLA for hospitals located in Alaska and Hawaii by multiplying the nonlabor-related portion of the standardized amount by a COLA factor. We note that OPMs COLA factors were calculated with a statutorily mandated cap of 25 percent.
As stated in the FY 2018 IPPS/LTCH
PPS final rule 82 FR 38530, under the COLA update methodology we finalized in the FY 2013 IPPS/LTCH PPS final
rule, we exercised our discretionary authority to adjust payments to hospitals in Alaska and Hawaii by incorporating this cap. In applying this finalized methodology for updating the COLA factors, for FY 2022, we are finalizing our proposal to continue to use such a cap, as our policy is based on OPMs COLA factors updated by the methodology described above.
Applying this methodology, the COLA factors that we are finalizing our proposal to establish for FY 2022 to adjust the nonlabor-related portion of the standardized amount for IPFs located in Alaska and Hawaii are shown in Table 2. For comparison purposes, we also are showing the COLA factors effective for FY 2018 through FY 2021.

Area
FY 2018
through FY 2021

FY2022
through FY2025

1.25
1.25

1.22
1.22

1.25
1.25

1.22
1.24

1.25
1.21
1.25
1.25

1.25
1.22
1.25
1.25

Alaska:
City of Anchorage and 80-kilometer 50-mile radius by road City of Fairbanks and 80-kilometer 50-mile radius by road City of Juneau and 80-kilometer 50-mile radius by road Rest of Alaska Hawaii:
City and County of Honolulu County of Hawaii County of Kauai County of Maui and County of Kalawao The final IPF PPS COLA factors for FY 2022 are also shown in Addendum A to this final rule, and is available at https www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/
InpatientPsychFacilPPS/tools.html.

lotter on DSK11XQN23PROD with RULES5

4. Final Adjustment for IPFs with a Qualifying Emergency Department ED
The IPF PPS includes a facility-level adjustment for IPFs with qualifying EDs.
We provide an adjustment to the Federal per diem base rate to account for the costs associated with maintaining a full-service ED. The adjustment is intended to account for ED costs incurred by a psychiatric hospital with a qualifying ED or an excluded psychiatric unit of an IPPS
hospital or a CAH, for preadmission services otherwise payable under the Medicare Hospital Outpatient
VerDate Sep<11>2014

21:11 Aug 03, 2021

Jkt 253001

Prospective Payment System OPPS, furnished to a beneficiary on the date of the beneficiarys admission to the hospital and during the day immediately preceding the date of admission to the IPF see 413.40c2, and the overhead cost of maintaining the ED. This payment is a facility-level adjustment that applies to all IPF
admissions with one exception which we described, regardless of whether a particular patient receives preadmission services in the hospitals ED.
The ED adjustment is incorporated into the variable per diem adjustment for the first day of each stay for IPFs with a qualifying ED. Those IPFs with a qualifying ED receive an adjustment factor of 1.31 as the variable per diem adjustment for day 1 of each patient stay. If an IPF does not have a qualifying ED, it receives an adjustment factor of
PO 00000

Frm 00016

Fmt 4701

Sfmt 4700

1.19 as the variable per diem adjustment for day 1 of each patient stay.
The ED adjustment is made on every qualifying claim except as described in this section of the proposed rule. As specified in 412.424d1vB, the ED
adjustment is not made when a patient is discharged from an IPPS hospital or CAH and admitted to the same IPPS
hospitals or CAHs excluded psychiatric unit. We clarified in the November 2004 IPF PPS final rule 69
FR 66960 that an ED adjustment is not made in this case because the costs associated with ED services are reflected in the DRG payment to the IPPS hospital or through the reasonable cost payment made to the CAH.
Therefore, when patients are discharged from an IPPS hospital or CAH and admitted to the same hospitals or CAHs excluded
E:FRFM04AUR5.SGM

04AUR5

ER04AU21.171

TABLE 2: Comparison oflPF PPS Cost-of-Living Adjustment Factors: IPFs Located in Alaska and Hawaii