Voglio sapere a riguardo di…

62000

Federal Register / Vol. 86, No. 213 / Monday, November 8, 2021 / Rules and Regulations
Act, which authorizes the Innovation Center to test innovative payment and service delivery models expected to reduce Medicare, Medicaid, and CHIP
expenditures while preserving or enhancing the quality of care furnished to the beneficiaries of such programs.
This final rule will refine the methodology for setting and updating achievement and improvement benchmarks for participating ESRD
facilities and Managing Clinicians serving the ESRD population over the remaining years of the ETC Model, among other changes. As described in detail in section V.B of this final rule, we believe it is necessary to adopt certain changes to the ETC Model.
Notwithstanding the changes, we continue to anticipate improvement in quality of care for beneficiaries and reduced expenditures under the ETC
Model inasmuch as the Model is designed to create incentives for Managing Clinicians and ESRD facilities to support beneficiaries, along with their families and caregivers, in choosing the optimal kidney replacement modality.
B. Overall Impact 1. ESRD PPS
We estimate that the final revisions to the ESRD PPS will result in an increase of approximately $290 million in payments to ESRD facilities in CY 2022, which includes the amount associated with updates to the outlier thresholds, payment rate update, updates to the wage index, and TPNIES payment.
2. AKI
We estimate that the updates to the AKI payment rate will result in an increase of approximately $1 million in payments to ESRD facilities in CY 2022.

lotter on DSK11XQN23PROD with RULES2

C. Detailed Economic Analysis In this section, we discuss the anticipated benefits, costs, and transfers associated with the changes in this final rule. Additionally, we estimate the total regulatory review costs associated with reading and interpreting this final rule.
1. Benefits for ESRD PPS and AKI
Under the CY 2022 ESRD PPS and AKI payment, ESRD facilities will continue to receive payment for renal dialysis services furnished to Medicare beneficiaries under a case-mix adjusted PPS. We continue to expect that making prospective payments to ESRD facilities will enhance the efficiency of the Medicare program. Additionally, we expect that updating ESRD PPS and AKI
payments by 1.9 percent based on the final CY 2022 ESRD PPS market basket update less the final CY 2022

VerDate Sep<11>2014

19:07 Nov 05, 2021

Jkt 256001

productivity adjustment 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 delivering renal dialysis services.
2. Costs a. ESRD PPS and AKI
We do not anticipate the provisions of this final rule regarding ESRD PPS and AKI rates-setting will create additional cost or burden to ESRD facilities.
b. ESRD QIP
For PY 2024 and PY 2025, we have reestimated the costs associated with the information collection requirements under the ESRD QIP with updated estimates of the total number of dialysis facilities. We note that the estimated total number of patients nationally, wages for Medical Records and Health Information Technicians or similar staff, and the estimated number of hours needed to complete data entry for EQRS
reporting are the same as they were in the proposed rule. We have made no changes to our methodology for calculating the annual burden associated with the information collection requirements for the EQRS
validation study previously known as the CROWNWeb validation study, the NHSN validation study, and EQRS
reporting. As discussed in section IV.C.
and section IV.D. of this final rule, we are finalizing our proposed measure suppressions that would apply for PY
2022 and updates to the scoring methodology and payment reductions for the PY 2022 ESRD QIP. We also announced an extension of EQRS
reporting requirements for facilities due to systems issues in the proposed rule.
However, we believe that none of the policies finalized in this final rule would affect our estimates of the annual burden associated with the Programs information collection requirements, as facilities are still expected to continue to collect measure data during this time period.
We also finalized the payment reduction scale using more recent data for the measures in the ESRD QIP
measure set. We estimate approximately $215 million in information collection burden, which includes the cost of complying with this rule, and an additional $17 million in estimated payment reductions across all facilities for PY 2024.
For PY 2025, we estimate that the proposed revisions to the ESRD QIP
would result in $215 million in information collection burden, and $17
million in estimated payment
PO 00000

Frm 00128

Fmt 4701

Sfmt 4700

reductions across all facilities, for an impact of $232 million as a result of the policies we have previously finalized and the policies we have finalized in this final rule.
c. ETC Model We estimate that the changes to the ETC Model will increase the Models projected direct savings from payment adjustments alone by $5 million over the duration of the Model. We estimate that the Model will generate $28 million in direct savings related to payment adjustments over 6.5 years with the adopted changes, and would generate $23 million in savings in the absence of the finalized changes.
3. Transfers for ESRD PPS and AKI
We estimate that the finalized updates to the ESRD PPS and AKI payment rate will result in a total in increase of approximately $290 million in payments to ESRD facilities in CY 2022, which includes the amount associated with updates to the outlier thresholds, and updates to the wage index. This estimate includes an increase of approximately $1 million in payments to ESRD facilities in CY 2022 due to the finalized updates to the AKI payment rate, of which approximately 20 percent is increased beneficiary co-insurance payments. We estimate approximately $230 million in transfers from the Federal Government to ESRD facilities due to increased Medicare program payments and approximately $60
million in transfers from beneficiaries to ESRD facilities due to increased beneficiary co-insurance payments as a result of this final rule.
4. Regulatory Review Cost Estimation 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 review the rule, we assume that the total number of unique commenters on this years proposed rule will be the number of reviewers of this final rule. We acknowledge that this assumption may understate or overstate the costs of reviewing this rule. It is possible that not all commenters reviewed this years rule in detail, and it is possible that some reviewers chose not to comment on the proposed rule.
For these reasons, we thought that the number of past commenters would be a fair estimate of the number of reviewers of this rule. We welcome any comments on the approach in estimating the number of entities, which will review
E:FRFM08NOR2.SGM

08NOR2