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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations increase factor with a productivity adjustment as required by section 1886s2Ai of the Act. In the FY
2022 IPF proposed rule 86 FR 19483, we proposed to use the same methodology described in the FY 2021
IPF PPS final rule 85 FR 47045 through 47046, with one proposed modification to the 2016-based IPF market basket.
For the price proxy for the For-profit Interest cost category of the 2016-based IPF market basket, we proposed to use the iBoxx AAA Corporate Bond Yield index instead of the Moodys AAA
Corporate Bond Yield index. Effective for December 2020, the Moodys AAA
Corporate Bond series is no longer available for use under license to IHS
Global Inc. IGI, the nationally recognized economic and financial forecasting firm with which we contract to forecast the components of the market baskets and multi-factor productivity MFP. Since IGI is no longer licensed to use and publish the Moodys series, IGI was required to discontinue the publication of the associated historical data and forecasts of this series.
Therefore, IGI constructed a bond yield index iBoxx that closely replicates the Moodys corporate bond yield indices currently used in the market baskets.
In the FY 2022 IPF PPS proposed rule, we stated that because the iBoxx AAA
Corporate Bond Yield index captures the same technical concept as the current corporate bond proxy and tracks similarly to the current measure that is no longer available, we believed that the iBoxx AAA Corporate Bond Yield index is technically appropriate to use in the 2016-based IPF market basket.
Based on IGIs fourth quarter 2020
forecast with historical data through the third quarter of 2020, the proposed 2016-based IPF market basket increase factor for FY 2022 was projected to be 2.3 percent. We also proposed that if more recent data became available after the publication of the proposed rule and before the publication of this final rule for example, a more recent estimate of the market basket update or MFP, we would use such data, if appropriate, to determine the FY 2022 market basket update in this final rule.
Section 1886s2Ai of the Act requires that, after establishing the increase factor for a FY, the Secretary shall reduce such increase factor for FY
2012 and each subsequent FY, by the productivity adjustment described in section 1886b3BxiII of the Act.
Section 1886b3BxiII of the Act sets forth the definition of this productivity adjustment. The statute defines the productivity adjustment to be equal to the 10-year moving average of changes in annual economy-wide,
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private nonfarm business MFP as projected by the Secretary for the 10year period ending with the applicable FY, year, cost reporting period, or other annual period the productivity adjustment. The U.S. Department of Labors Bureau of Labor Statistics BLS
publishes the official measure of private nonfarm business MFP. Please see http www.bls.gov/mfp for the BLS
historical published MFP data. A
complete description of the MFP
projection methodology is available on the CMS website at https
www.cms.gov/Research-StatisticsDataand-Systems/Statistics-TrendsandReports/
MedicareProgramRatesStats/
MarketBasketResearch.html. We note that effective with FY 2022 and forward, CMS is changing the name of this adjustment to refer to it as the productivity adjustment rather than the MFP adjustment. We note that the adjustment relies on the same underlying data and methodology. This new terminology is more consistent with the statutory language described in section 1886s2Ai of the Act.
Using IGIs fourth quarter 2020
forecast, the productivity adjustment for FY 2022 was projected to be 0.2 percent.
We proposed to then reduce the proposed 2.3 percent IPF market basket update by the estimated productivity adjustment for FY 2022 of 0.2
percentage point. Therefore, the proposed FY 2022 IPF update was equal to 2.1 percent 2.3 percent market basket update reduced by the 0.2 percentage point productivity adjustment.
Furthermore, we proposed that if more recent data became available after the publication of the proposed rule and before the publication of this final rule for example, a more recent estimate of the market basket or MFP, we would use such data, if appropriate, to determine the FY 2022 market basket update and productivity adjustment in this final rule.
Based on the more recent data available for this FY 2022 IPF final rule that is, IGIs second quarter 2021
forecast of the 2016-based IPF market basket with historical data through the first quarter of 2021, we estimate that the IPF FY 2022 market basket update is 2.7 percent. The current estimate of the productivity adjustment for FY 2022
is 0.7 percentage point. Therefore, the current estimate of the FY 2022 IPF
increase factor is equal to 2.0 percent 2.7 percent market basket update reduced by 0.7 percentage point productivity adjustment.
We invited public comment on our proposals for the FY 2022 market basket update and productivity adjustment.

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The following is a summary of the public comments received on the proposed FY 2022 market basket update and productivity adjustment and our responses:
Comment: One commenter supported the update to the IPF payment rates of 2.1 percent.
Response: We thank the commenter for their support.
Comment: One commenter stated that given the growing behavioral health and substance abuse crisis made worse by the COVID19 Public Health Emergency PHE, that CMS should provide additional payment for IPFs in the future.
Response: We understand the commenters concern. We acknowledge that the COVID19 PHE has amplified the growing need for behavioral health services in this country and remain committed to trying to find ways to mitigate its impact on IPFs. Our goal is to ensure that the IPF payment rates accurately reflect the best available data.
For example, as discussed in section VI.C.3 of this final rule, in comparing and analyzing FY 2019 and FY 2020
claims, we determined that the COVID
19 PHE appears to have significantly impacted the FY 2020 IPF claims such that the FY 2019 claims are the best available data to set the outlier fixed dollar loss threshold for FY 2022.
Therefore, we deviated from our longstanding practice of using the most recent available year of claims, that is, FY 2020 claims, for estimating IPF PPS
payments in FY 2022. We will continue to analyze more recent available IPF
claims data to better understand both the shortand long-term effects of the COVID19 PHE on the IPF PPS.
Final Decision: After consideration of the comments we received, we are finalizing a FY 2022 IPF update equal to 2.0 percent based on the more recent data available.
3. Final FY 2022 IPF Labor-Related Share Due to variations in geographic wage levels and other labor-related costs, we believe that payment rates under the IPF
PPS should continue to be adjusted by a geographic wage index, which would apply to the labor-related portion of the Federal per diem base rate hereafter referred to as the labor-related share.
The labor-related share is determined by identifying the national average proportion of total costs that are related to, influenced by, or vary with the local labor market. We proposed to continue to classify a cost category as laborrelated if the costs are labor-intensive and vary with the local labor market.

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