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Federal Register / Vol. 86, No. 154 / Friday, August 13, 2021 / Rules and Regulations
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rule. As discussed elsewhere in this final rule, these estimates are based on the best available LTCH claims data and other factors, such as the application of inflation factors to estimate costs for HCO cases in each year.
The resulting analyses can then be used to compare how our policies applicable to LTCH PPS standard Federal payment rate cases affect different groups of LTCHs.
For the following analysis, we group hospitals based on characteristics provided in the OSCAR data, cost report data in HCRIS, and PSF data. Hospital groups included the following:
Location: large urban/other urban/rural.
Participation date.
Ownership control.
Census region.
Bed size.
c. Calculation of LTCH PPS Payments for LTCH PPS Standard Federal Payment Rate Cases For purposes of this impact analysis, to estimate the per discharge payment effects of our policies on payments for LTCH PPS
standard Federal payment rate cases, we simulated FY 2021 and final FY 2022
payments on a case-by-case basis using historical LTCH claims from the FY 2019
MedPAR files that met or would have met the criteria to be paid at the LTCH PPS standard Federal payment rate if the statutory patientlevel criteria had been in effect at the time of discharge for all cases in the FY 2019
MedPAR files. For modeling FY 2021 LTCH
PPS payments, we used the FY 2021 standard Federal payment rate of $43,755.34 or $42,899.90 for LTCHs that failed to submit quality data as required under the requirements of the LTCH QRP. Similarly, for modeling payments based on the FY 2022
LTCH PPS standard Federal payment rate, we used the final FY 2022 standard Federal payment rate of $44,713.67 or $43,836.08 for LTCHs that failed to submit quality data as required under the requirements of the LTCH
QRP. In each case, we applied the applicable adjustments for area wage levels and the COLA for LTCHs located in Alaska and
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Hawaii. Specifically, for modeling FY 2021
LTCH PPS payments, we used the current FY
2021 labor-related share 68.1 percent, the wage index values established in the Tables 12A and 12B listed in the Addendum to the FY 2021 IPPS/LTCH PPS final rule which are available via the internet on the CMS
website, the FY 2021 HCO fixed-loss amount for LTCH PPS standard Federal payment rate cases of $27,195 as reflected in the FY 2021
IPPS/LTCH PPS final rule, and the FY 2021
COLA factors shown in the table in section V.C. of the Addendum to that final rule to adjust the FY 2021 nonlabor-related share 31.9 percent for LTCHs located in Alaska and Hawaii. Similarly, for modeling FY 2022
LTCH PPS payments, we used the FY 2022
LTCH PPS labor-related share 67.9 percent, the FY 2022 wage index values from Tables 12A and 12B listed in section VI. of the Addendum to this final rule which are available via the internet on the CMS
website, the FY 2022 HCO fixed-loss amount for LTCH PPS standard Federal payment rate cases of $33,015 as discussed in section V.D.3. of the Addendum to this final rule, and the FY 2022 COLA factors shown in the table in section V.C. of the Addendum to this final rule to adjust the FY 2022 nonlaborrelated share 32.1 percent for LTCHs located in Alaska and Hawaii. We note that in modeling payments for HCO cases for LTCH PPS standard Federal payment rate cases, we inflated charges reported on the FY
2019 claims by the charge inflation factors in section V.D.3.b. of the Addendum to this final rule. We also note that in modeling payments for HCO cases for LTCH PPS
standard Federal payment rate cases, we estimated the cost of each case by multiplying the inflated charges by the adjusted CCRs that we determined using our methodology described in section V.D.3.b. of the Addendum to this final rule.
The impacts that follow reflect the estimated losses or gains among the various classifications of LTCHs from FY
2021 to FY 2022 based on the payment rates and policy changes applicable to LTCH PPS
standard Federal payment rate cases
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presented in this final rule. Table IV
illustrates the estimated aggregate impact of the change in LTCH PPS payments for LTCH
PPS standard Federal payment rate cases among various classifications of LTCHs. As discussed previously, these impacts do not include LTCH PPS site neutral payment rate cases.
The first column, LTCH Classification, identifies the type of LTCH.
The second column lists the number of LTCHs of each classification type.
The third column identifies the number of LTCH cases expected to meet the LTCH
PPS standard Federal payment rate criteria.
The fourth column shows the estimated FY 2021 payment per discharge for LTCH
cases expected to meet the LTCH PPS
standard Federal payment rate criteria as described previously.
The fifth column shows the estimated FY
2022 payment per discharge for LTCH cases expected to meet the LTCH PPS standard Federal payment rate criteria as described previously.
The sixth column shows the percentage change in estimated payments per discharge for LTCH cases expected to meet the LTCH
PPS standard Federal payment rate criteria from FY 2021 to FY 2022 due to the annual update to the standard Federal rate as discussed in section V.A.2. of the Addendum to this final rule.
The seventh column shows the percentage change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2021 to FY 2022
for changes to the area wage level adjustment that is, the updated hospital wage data and labor-related share and the application of the corresponding budget neutrality factor as discussed in section V.B.6. of the Addendum to this final rule.
The eighth column shows the percentage change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2021 Column 4 to FY 2022
Column 5 for all changes.
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