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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
FY 2019 and FY 2020 claims, the distributional effects are very similar.
For example, we estimate the largest increase in payments to be 0.6 percent for IPFs in the South Atlantic region, and the largest decrease in payments to be 0.5 percent for IPFs in the East South Central region, based on either the FY 2019 or FY 2020 claims.
Finally, column 5 compares the total final changes reflected in this final rule for FY 2022 to the estimates for FY 2021
without these changes. The average estimated increase for all IPFs is approximately 2.1 percent based on the FY 2019 claims, or 0.9 percent based on the FY 2020 claims. These estimated net increases include the effects of the 2016based market basket update of 2.7
percent reduced by the productivity adjustment of 0.7 percentage point, as required by section 1886s2Ai of the Act. They also include the overall estimated 0.1 percent increase in estimated IPF outlier payments as a percent of total payments from updating the outlier fixed dollar loss threshold amount. In addition, column 5 includes the distributional effects of the final updates to the IPF wage index, the labor-related share, and the final updated COLA factors, whose impacts are displayed in column 4. Based on the FY 2020 claims distribution, the increase to estimated payments due to the market basket update factor are offset in large part for some provider types by the increase to the outlier fixed dollar loss threshold.
In summary, comparing the impact results for the FY 2019 and FY 2020
claims, the largest difference in the results continues to be due to the update to the outlier fixed dollar loss threshold, which is the same result we observed in the FY 2022 IPF PPS proposed rule 86
FR 19524. Estimated outlier payments increased and estimated total PPS
payments decreased, when comparing FY 2020 to FY 2019. As a result, we continue to believe that FY 2019 claims, rather than FY 2020 claims, are the best available data for setting the FY 2022
final outlier fixed dollar loss threshold.
Furthermore, the distributional effects of the updates presented in column 4 of Table 18 the budget-neutral update to the IPF wage index, the LRS, and the final updated COLA factors are very similar when using the FY 2019 or FY
2020 claims data. Therefore, we believe the FY 2019 claims are the best available data for estimating payments in this FY 2022 final rulemaking, and we are finalizing our proposal to use the FY 2019 claims to calculate the outlier fixed dollar loss threshold and wage index budget neutrality factor.

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IPF payments are therefore estimated to increase by 2.1 percent in urban areas and 2.2 percent in rural areas based on this finalized policy. Overall, IPFs are estimated to experience a net increase in payments as a result of the updates in this final rule. The largest payment increase is estimated at 2.7 percent for IPFs in the South Atlantic region.
4. Effect on Beneficiaries Under the FY 2022 IPF PPS, IPFs will continue to receive payment based on the average resources consumed by patients for each day. Our longstanding payment methodology reflects the differences in patient resource use and costs among IPFs, as required under section 124 of the BBRA. We expect that updating IPF PPS rates as finalized in this rule will improve or maintain beneficiary access to high quality care by ensuring that payment rates reflect the best available data on the resources involved in inpatient psychiatric care and the costs of these resources. We continue to expect that paying prospectively for IPF services under the FY 2022 IPF PPS will enhance the efficiency of the Medicare program.
As discussed in sections IV.E.2, IV.E.3, and V.A.2.d of this final rule, we expect that additional program measures will improve follow-up for patients with both mental health and substance use disorders and ensure health-care personnel COVID19
vaccinations. We also estimate an annualized estimate of $512,065
reduction in information collection burden as a result our measure removals. Therefore, we expect that the final updates to the IPFQR program will improve quality for beneficiaries.
5. Effects of Updates to the IPFQR
Program As discussed in section V. of this final rule and in accordance with section 1886s4Ai of the Act, we will apply a 2 percentage point reduction to the FY
2022 market basket update for IPFs that have failed to comply with the IPFQR
Program requirements for FY 2022, including reporting on the required measures. In section V. of this final rule, we discuss how the 2 percentage point reduction will be applied. For FY 2021, of the 1,634 IPFs eligible for the IPFQR
Program, 43 IPFs 2.6 percent did not receive the full market basket update because of the IPFQR Program; 31 of these IPFs chose not to participate and 12 did not meet the requirements of the program. We anticipate that even fewer IPFs would receive the reduction for FY
2022 as IPFs become more familiar with the requirements. Thus, we estimate that the IPFQR Program will have a
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negligible impact on overall IPF
payments for FY 2022.
Based on the IPFQR Program policies finalized in this final rule, we estimate a total decrease in burden of 287,924
hours across all IPFs, resulting in a total decrease in information collection burden of $512,065 across all IPFs. As discussed in section VI. of this final rule, we will attribute the cost savings associated with the proposals to the year in which these savings begin; for the purposes of all the policies in this final rule, that year is FY 2023. Further information on these estimates can be found in section VI. of this final rule.
We intend to closely monitor the effects of the IPFQR Program on IPFs and help facilitate successful reporting outcomes through ongoing stakeholder education, national trainings, and a technical help desk.
6. Regulatory Review Costs If regulations impose administrative costs on private entities, such as the time needed to read and interpret this final rule, we should estimate the cost associated with regulatory review. Due to the uncertainty involved with accurately quantifying the number of entities that will be directly impacted and will review this final rule, we assume that the total number of unique commenters on the most recent IPF
proposed rule will be the number of reviewers of this final rule. For this FY
2022 IPF PPS final rule, the most recent IPF proposed rule was the FY 2022 IPF
PPS proposed rule, and we received 898
unique comments on this proposed rule.
We acknowledge that this assumption may understate or overstate the costs of reviewing this final rule. It is possible that not all commenters reviewed the FY 2021 IPF proposed rule in detail, and it is also possible that some reviewers chose not to comment on that proposed rule. For these reasons, we thought that the number of commenters would be a fair estimate of the number of reviewers who are directly impacted by this final rule. We solicited comments on this assumption.
We also recognize that different types of entities are in many cases affected by mutually exclusive sections of this final rule; therefore, for the purposes of our estimate, we assume that each reviewer reads approximately 50 percent of this final rule.
Using the May, 2020 mean average wage information from the BLS for medical and health service managers Code 119111, we estimate that the cost of reviewing this final rule is $114.24 per hour, including overhead and fringe benefits https www.bls.gov/
oes/current/oes119111.htm. Assuming
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