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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations would reduce burden on the provider.
While comments were overwhelmingly supportive, we did not receive any comments that would support burden changes.
We are also revising the provisions at 418.76h1iii to state that if an area of concern is verified by the hospice during the on-site visit, then the hospice must conduct, and the hospice aide must complete, a competency evaluation related to the deficient and related skills in accordance with 418.76c. While many commenters indicated that the proposed changes increase efficiency of training, none provided specific information or data to describe a change in burden.
Additionally, we believe that both the requirements at 418.76h are exempt from the PRA. In accordance with the implementing regulations of the PRA at 5 CFR 1320.3b2, we believe competency evaluations are a usual and customary business practice and we state as such in the information collection request associated with the Hospice CoPsCMS10277 OMB
control number 09381067. Therefore, we are not seeking OMB approval for any information collection or recordkeeping activities that may be conducted in connection with the revisions to 418.76h.
VII. Regulatory Impact Analysis
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A. Statement of Need This final rule meets the requirements of our regulations at 418.306c and d, which require annual issuance, in the Federal Register, of the hospice wage index based on the most current available CMS hospital wage data, including any changes to the definitions of CBSAs or previously used MSAs, as well as any changes to the methodology for determining the per diem payment rates. This final rule also updates payment rates for each of the categories of hospice care, described in 418.302b, for FY 2022 as required under section 1814i1CiiVII of the Act. The payment rate updates are subject to changes in economy-wide productivity as specified in section 1886b3BxiII of the Act. Lastly, section 3004 of the Affordable Care Act amended the Act to authorize a quality reporting program for hospices, and this rule discusses changes in the requirements for the HQRP in accordance with section 1814i5 of the Act.
B. Overall Impacts We estimate that the aggregate impact of the payment provisions in this rule will result in an increase of $480

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million in payments to hospices, resulting from the hospice payment update percentage of 2.0 percent for FY
2022. The impact analysis of this rule represents the projected effects of the changes in hospice payments from FY
2021 to FY 2022. Using the most recent complete data available at the time of rulemaking, in this case FY 2020
hospice claims data as of January 15, 2021, we apply the current FY 2021
wage index with the current labor shares. Using the same FY 2020 data, we apply the FY 2022 wage index and the current labor share values to simulate FY 2022 payments. We then apply a budget neutrality adjustment so that the aggregate simulated payments do not increase or decrease due to changes in the wage index. Then, using the same FY 2020 data, we apply the FY 2022
wage index and the current labor share values to simulate FY 2022 payments and compare simulated payments using the FY 2022 wage index and the proposed revised labor shares. We then apply a budget neutrality adjustment so that the aggregate simulated payments do not increase or decrease due to changes in the labor share values.
Certain events may limit the scope or accuracy of our impact analysis, because such an analysis is susceptible to forecasting errors due to other changes in the forecasted impact time period.
The nature of the Medicare program is such that the changes may interact, and the complexity of the interaction of these changes could make it difficult to predict accurately the full scope of the impact upon hospices.
We have examined the impacts of this rule as required by Executive Order 12866 on Regulatory Planning and Review September 30, 1993, Executive Order 13563 on Improving Regulation and Regulatory Review January 18, 2011, the Regulatory Flexibility Act RFA September 19, 1980, Pub. L. 96
354, section 1102b of the Social Security Act, section 202 of the Unfunded Mandates Reform Act of 1995
March 22, 1995; Pub. L. 1044, Executive Order 13132 on Federalism August 4, 1999, and the Congressional Review Act 5 U.S.C. 8042.
Executive Orders 12866 and 13563
direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits including potential economic, environmental, public health and safety effects, distributive impacts, and equity. Section 3f of Executive Order 12866 defines a significant regulatory action as an action that is likely to result in a rule: 1 Having an annual
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effect on the economy of $100 million or more in any 1 year, or adversely and materially affecting a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or state, local or tribal governments or communities also referred to as economically significant; 2 creating a serious inconsistency or otherwise interfering with an action taken or planned by another agency; 3 materially altering the budgetary impacts of entitlement grants, user fees, or loan programs or the rights and obligations of recipients thereof; or 4 raising novel legal or policy issues arising out of legal mandates, the Presidents priorities, or the principles set forth in the Executive Order.
In accordance with the provisions of Executive Order 12866, this regulation was reviewed by OMB.
A regulatory impact analysis RIA
must be prepared for major rules with economically significant effects $100
million or more in any 1 year. Based on our estimates, OMBs Office of Information and Regulatory Affairs has determined that this rulemaking is economically significant as measured by the $100 million threshold, and hence also a major rule under Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 also known as the Congressional Review Act, 5 U.S.C. 8042. Accordingly, we have prepared a RIA that, to the best of our ability presents the costs and benefits of the rulemaking.
C. Detailed Economic Analysis 1. Hospice Payment Update for FY 2022
The FY 2022 hospice payment impacts appear in Table 25. We tabulate the resulting payments according to the classifications for example, provider type, geographic region, facility size, and compare the difference between current and future payments to determine the overall impact. The first column shows the breakdown of all hospices by provider type and control non-profit, for-profit, government, other, facility location, facility size. The second column shows the number of hospices in each of the categories in the first column. The third column shows the effect of using the FY 2022 updated wage index data. This represents the effect of moving from the FY 2021
hospice wage index to the FY 2022
hospice wage index. The fourth column shows the effect of the final rebased labor shares. The aggregate impact of the changes in column three and four is zero percent, due to the hospice wage index standardization factor and the
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