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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
million in 1995 dollars, updated annually for inflation. In 2021, that threshold is approximately $158
million. This final rule does not mandate any requirements for state, local, or tribal governments, or for the private sector. This final rule would not impose a mandate that will result in the expenditure by state, local, and Tribal Governments, in the aggregate, or by the private sector, of more than $158
million in any one year.

purposes of accounting for indirect teaching costs.

Displaced resident means a displaced resident as defined in 413.79h1iii for the purposes of accounting for indirect teaching costs.

3. Section 412.424 is amended by revising paragraph d1iiiF to read as follows:

H. Federalism
412.424 Methodology for calculating the Federal per diem payment system.

Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. This final rule does not impose substantial direct costs on state or local governments or preempt state law.
I, Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & Medicaid Services, approved this document on July 23, 2021.

List of Subjects in 42 CFR Part 412
Administrative practice and procedure, Health facilities, Medicare, Puerto Rico, Reporting and recordkeeping requirements.
For the reasons set forth in the preamble, the Centers for Medicare &
Medicaid Services is amending 42 CFR
chapter IV as set forth below:
PART 412PROSPECTIVE PAYMENT
SYSTEMS FOR INPATIENT HOSPITAL
SERVICES
1. The authority citation for part 412
continues to read as follows:

Authority: 42 U.S.C. 1302 and 1395hh.

2. Section 412.402 is amended by adding definitions for Closure of an IPF, Closure of an IPFs residency training program, and Displaced resident in alphabetical order to read as follows:

412.402

Definitions.

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Closure of an IPF means closure of a hospital as defined in 413.79h1i by an IPF meeting the requirements of 412.404b for the purposes of accounting for indirect teaching costs.
Closure of an IPFs residency training program means closure of a hospital residency training program as defined in 413.79h1ii by an IPF meeting the requirements of 412.404b for the
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d
1
iii
F Closure of an IPF or IPF residency training program1 Closure of an IPF.
For cost reporting periods beginning on or after July 1, 2011, an IPF may receive a temporary adjustment to its FTE cap to reflect displaced residents added because of another IPFs closure if the IPF meets the following criteria:
i The IPF is training additional displaced residents from an IPF that closed on or after July 1, 2011.
ii No later than 60 days after the IPF
begins to train the displaced residents, the IPF submits a request to its Medicare contractor for a temporary adjustment to its cap, documents that the IPF is eligible for this temporary adjustment by identifying the displaced residents who have come from the closed IPF and have caused the IPF to exceed its cap, and specifies the length of time the adjustment is needed.
2 Closure of an IPFs residency training program. If an IPF that closes its residency training program on or after July 1, 2011, agrees to temporarily reduce its FTE cap according to the criteria specified in paragraph d1iiiF2ii of this section, another IPFs may receive a temporary adjustment to its FTE cap to reflect displaced residents added because of the closure of the residency training program if the criteria specified in paragraph d1iiiF2i of this section are met.
i Receiving IPFs. For cost reporting periods beginning on or after July 1, 2011, an IPF may receive a temporary adjustment to its FTE cap to reflect displaced residents added because of the closure of another IPFs residency training program if the IPF is training additional displaced residents from the residency training program of an IPF
that closed a program; and if no later than 60 days after the IPF begins to train the displaced residents, the IPF submits to its Medicare Contractor a request for a temporary adjustment to its FTE cap,
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documents that it is eligible for this temporary adjustment by identifying the displaced residents who have come from another IPFs closed program and have caused the IPF to exceed its cap, specifies the length of time the adjustment is needed, and submits to its Medicare contractor a copy of the FTE
reduction statement by the hospital that closed its program, as specified in paragraph d1iiiF2ii of this section.
ii IPF that closed its program. An IPF that agrees to train displaced residents who have been displaced by the closure of another IPFs program may receive a temporary FTE cap adjustment only if the hospital with the closed program temporarily reduces its FTE cap based on the FTE of displaced residents in each program year training in the program at the time of the programs closure. This yearly reduction in the FTE cap will be determined based on the number of those displaced residents who would have been training in the program during that year had the program not closed. No later than 60
days after the displaced residents who were in the closed program begin training at another hospital, the hospital with the closed program must submit to its Medicare contractor a statement signed and dated by its representative that specifies that it agrees to the temporary reduction in its FTE cap to allow the IPF training the displaced residents to obtain a temporary adjustment to its cap; identifies the displaced residents who were in training at the time of the programs closure; identifies the IPFs to which the displaced residents are transferring once the program closes; and specifies the reduction for the applicable program years.

4. Section 412.434 is amended by revising paragraph b3 to read as follows:

412.434 Reconsideration and appeals procedures of Inpatient Psychiatric Facilities Quality Reporting IPFQR
Program decisions

b
3 Contact information for the inpatient psychiatric facilitys chief executive officer and QualityNet security official, including each individuals name, email address, telephone number, and physical mailing address;

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