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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations an average reading speed of 250 words per minute, we estimate that it would take approximately 128 minutes 2.13
hours for the staff to review half of this final rule, which is approximately 32,000 words. For each IPF that reviews the final rule, the estimated cost is 2.13
$114.24 or $243.33. Therefore, we estimate that the total cost of reviewing this final rule is $ 218,510.34 $243.33
898 reviewers.
D. Alternatives Considered The statute does not specify an update strategy for the IPF PPS and is broadly written to give the Secretary discretion in establishing an update methodology.
We continue to believe it is appropriate to routinely update the IPF PPS so that it reflects the best available data about differences in patient resource use and costs among IPFs as required by the statute. Therefore, we are finalizing our
proposal to update the IPF PPS using the methodology published in the November 2004 IPF PPS final rule;
applying the 2016-based IPF PPS market basket update for FY 2022 of 2.7
percent, reduced by the statutorily required productivity adjustment of 0.7
percentage point along with the wage index budget neutrality adjustment to update the payment rates; and finalizing a FY 2022 IPF wage index which uses the FY 2022 pre-floor, pre-reclassified IPPS hospital wage index as its basis.
As discussed in section VI.C.3 of this final rule, we also considered using FY
2020 claims data to determine the final FY 2022 outlier fixed dollar loss threshold, wage index budget neutrality factor, per diem base rate, and ECT rate.
For the reasons discussed in that section, we are finalizing our proposal to use FY 2019 claims data.

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E. Accounting Statement As required by OMB Circular A4
available at www.whitehouse.gov/sites/
whitehouse.gov/files/omb/circulars/A4/
a-4.pdf, in Table 19, we have prepared an accounting statement showing the classification of the expenditures associated with the updates to the IPF
wage index and payment rates in this final rule. Table 19 provides our best estimate of the increase in Medicare payments under the IPF PPS as a result of the changes presented in this final rule and based on the data for 1,519
IPFs with data available in the PSF and with claims in our FY 2019 MedPAR
claims dataset. Table 19 also includes our best estimate of the cost savings for the 1,634 IPFs eligible for the IPFQR
Program. Lastly, Table 19 also includes our best estimate of the costs of reviewing and understanding this final rule.

TABLE 19: Accounting Statement: Classification of Estimated Costs, Savings, and Transfers
Regulatory Review Costs Annualized Monetized Costs Savings
Annualized Monetized Transfers from Federal Government to TPF
Medicare Providers
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F. Regulatory Flexibility Act The RFA requires agencies to analyze options for regulatory relief of small entities if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most IPFs and most other providers and suppliers are small entities, either by nonprofit status or having revenues of $8 million to $41.5 million or less in any 1 year.
Individuals and states are not included in the definition of a small entity.
Because we lack data on individual hospital receipts, we cannot determine the number of small proprietary IPFs or the proportion of IPFs revenue derived from Medicare payments. Therefore, we assume that all IPFs are considered small entities.

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Year dollars
Period covered
Discount rate
-

-

2020

-

-0.51

-0.38

-0.64

2019

7%

FY 2023FY 2031

2019

3%

-0.44
80

-0.33

-0.54

-

-

FY2022

-

FY2023FY 2031
FY2022

The Department of Health and Human Services generally uses a revenue impact of 3 to 5 percent as a significance threshold under the RFA. As shown in Table 18, we estimate that the overall revenue impact of this final rule on all IPFs is to increase estimated Medicare payments by approximately 2.1 percent.
As a result, since the estimated impact of this final rule is a net increase in revenue across almost all categories of IPFs, the Secretary has determined that this final rule will have a positive revenue impact on a substantial number of small entities.
In addition, section 1102b of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102b of the Act, we define a small rural hospital
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FY2022

as a hospital that is located outside of a metropolitan statistical area and has fewer than 100 beds. As discussed in section V.C.1 of this final rule, the rates and policies set forth in this final rule will not have an adverse impact on the rural hospitals based on the data of the 239 rural excluded psychiatric units and 60 rural psychiatric hospitals in our database of 1,519 IPFs for which data were available. Therefore, the Secretary has certified that this final rule will not have a significant impact on the operations of a substantial number of small rural hospitals.
G. Unfunded Mandate Reform Act UMRA
Section 202 of the Unfunded Mandates Reform Act of 1995 UMRA
also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100

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ER04AU21.191

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