Medicare Program; Fiscal Year (FY) 2022 Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Updates for Fiscal Year Beginning October 1, 2021 (FY 2022); Correction, 54631-54636 [2021-21546]
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Federal Register / Vol. 86, No. 189 / Monday, October 4, 2021 / Rules and Regulations
§ 301–74.4
[Amended]
3. Amend § 301–74.4 by removing the
last sentence of the paragraph.
■
document published on August 4, 2021.
Accordingly, the corrections are
effective October 1, 2021.
Appendix E to Chapter 301—[Removed
and Reserved]
II. Summary of Errors
4. Remove and reserve Appendix E to
Chapter 301.
1. Inpatient Psychiatric Facilities
Prospective Payment System (IPF PPS)
Corrections
There was a technical error in the
simulation of Inpatient Psychiatric
Facilities (IPF) payments that affected
the impact analysis and the calculation
of the final outlier fixed dollar loss
threshold amount. In estimating the
percentage of outlier payments as a
percentage of total payments, we
inadvertently applied provider
information from the January, 2021
update of the Provider-Specific File
(PSF) instead of the most recently
available update from April, 2021. For
fiscal year (FY) 2022, we finalized our
proposal to update the IPF outlier
threshold amount using FY 2019 claims
data and the same methodology that we
used to set the initial outlier threshold
amount in the Rate Year 2007 IPF PPS
final rule (71 FR 27072 and 27073). In
accordance with that longstanding
methodology, the calculation of
estimated outlier payments should have
used the April, 2021 provider
information rather than the January,
2021 provider information.
As a result of the error in estimating
outlier payments, the FY 2022 IPF PPS
final rule overstated the estimate of
increased transfers from the federal
government to IPF providers. We
estimated $80 million in increased
transfers from the federal government to
IPF providers; however, based on the
corrected calculation of the outlier fixed
dollar loss threshold amount, the correct
estimate of increased transfers from the
federal government to IPF providers
should be $70 million. Also, as a result
of the error in estimating outlier
payments, the FY 2022 IPF PPS final
rule incorrectly estimated and described
the impact of the final rule on various
provider types and the total number of
providers included in the analysis.
On page 42608, in the third column,
second bullet, seventh sub-bullet, the
fixed dollar loss threshold amount
should be changed from ‘‘$14,470’’ to
‘‘$16,040’’.
On page 42609, the table summarizing
Total Transfers and Cost reductions
should reflect the corrected estimate of
increased payments to IPFs during FY
2022, which should be corrected from
$80 million to $70 million.
On page 42623, in the third column,
in the third full paragraph, we
incorrectly stated that IPF outlier
■
[FR Doc. 2021–21391 Filed 10–1–21; 8:45 am]
BILLING CODE P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 412
[CMS–1750–CN]
RIN 0938–AU40
Medicare Program; Fiscal Year (FY)
2022 Inpatient Psychiatric Facilities
Prospective Payment System and
Quality Reporting Updates for Fiscal
Year Beginning October 1, 2021 (FY
2022); Correction
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
AGENCY:
This document corrects
technical errors that appeared in the
final rule published in the Federal
Register on August 4, 2021 entitled
‘‘Medicare Program; FY 2022 Inpatient
Psychiatric Facilities Prospective
Payment System and Quality Reporting
Updates for Fiscal Year Beginning
October 1, 2021 (FY 2022)’’.
DATES: This correction is effective
October 1, 2021.
FOR FURTHER INFORMATION CONTACT:
Lauren Lowenstein, (410) 786–4507
for information regarding the Inpatient
Psychiatric Facility Quality Reporting
(IPFQR) Program.
The IPF Payment Policy mailbox at
IPFPaymentPolicy@cms.hhs.gov for
general information.
Nicolas Brock, (410) 786–5148 or
Theresa Bean (410) 786–2287, for
information regarding the outlier fixed
dollar loss threshold amount and the
regulatory impact analysis.
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
In FR Doc. 2021–16336 of August 4,
2021 (86 FR 42608), there were a
number of technical errors that are
identified and corrected in this
correcting document. The provisions in
this correction document are effective as
if they had been included in the
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A. Summary of Errors in the Preamble
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54631
payments as a percentage of total
estimated payments were approximately
1.9 percent in FY 2021. The correct
percentage should be 2.1 percent.
On page 42623, in the third column,
in the third full paragraph, we
incorrectly stated that we were
decreasing the outlier threshold amount
to $14,470. The correct update to the
outlier threshold amount should be
increased to $16,040.
2. Inpatient Psychiatric Facilities
Quality Reporting (IPFQR) Program
Corrections
On page 42634, in footnote 93, we
made a typographical error and listed
the date information was accessed as
July 6 instead of July 16.
On page 42645, in the second column
in the first full paragraph, we
inadvertently omitted several words
from the phrase ‘‘is this measure’s
objective’’ which should read ‘‘is not
this measure’s primary objective’’.
On page 42647, in footnote 154, we
inadvertently omitted the end of the
footnote, which should read, ‘‘.,
Alcohol: A probable risk factor of
COVID–19 severity, 7–20–2021.
doi:10.1111/add.15194’’.
On page 42649, in the third column,
in the first full paragraph, we made a
typographical error and referred to ‘‘a
comprehensive program to address
topped out’’ instead of ‘‘a
comprehensive program to address
tobacco use’’.
On page 42657, in the last paragraph
under subsection b, we inadvertently
included the phrase ‘‘to no longer
require facilities. . .’’.
On page 42659, in Table 7, we
inadvertently included the ‘‘Timely
Transmission of Transition Record
(Discharges from an Inpatient Facility to
Home/Self Care or any Other Site of
Care)’’ in the table.
On page 42661, in the last paragraph,
last sentence, under V. Collection of
Information Requirements, we
inadvertently stated ‘‘We have not made
any changes from what was proposed.’’
On page 42669, in Table 15, we made
a typographical error and listed the
annual cost update for the removal of
the Timely Transmission of Transition
Record (Discharges from an Inpatient
Facility to Home/Self Care or Any Other
Site of Care) and the total cost update
as (10,199,836.5050) instead of
(10,199,836.50).
3. Regulatory Impact Analysis
Corrections
On page 42672, in the second column,
we incorrectly stated that ‘‘we estimate
that the total impact of these changes for
FY 2022 payments compared to FY 2021
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Federal Register / Vol. 86, No. 189 / Monday, October 4, 2021 / Rules and Regulations
payments will be a net increase of
approximately $80 million. This reflects
an $75 million increase from the update
to the payment rates (+$100 million
from the 2nd quarter 2021 IGI forecast
of the 2016-based IPF market basket of
2.7 percent, and ¥$25 million for the
productivity adjustment of 0.7
percentage point), as well as a $5
million increase as a result of the update
to the outlier threshold amount. Outlier
payments are estimated to change from
1.9 percent in FY 2021 to 2.0 percent of
total estimated IPF payments in FY
2022’’. This paragraph should be revised
to reflect that outlier payments are
estimated to change from 2.1 percent in
FY 2021 to 2.0 percent in FY 2022, and
that the update to the outlier threshold
will result in a $5 million decrease and
a net increase of approximately $70
million in FY 2022 payments.
On page 42672 in the third column,
in the fourth full paragraph under C.
Detailed Economic Analysis, ‘‘$80
million’’ should be replaced with ‘‘$70
million’’ and ‘‘$5 million increase’’
should be replaced with ‘‘$5 million
decrease’’.
On pages 42674 and 42675, Table 18
reflects the impact to providers of
updating the outlier fixed dollar loss
threshold amount based on the
inaccurate calculation of estimated FY
2021 outlier payments; therefore, Table
18 should be updated to reflect the
correct calculations.
On page 42675 in the first column, in
the second full paragraph under 3.
Impact Results, we incorrectly stated
that the number of IPFs included in the
analysis for FY 2019 claims is 1,519.
The correct number is 1,520 IPFs.
On page 42675, in the first column, in
the third full paragraph, we incorrectly
stated that ‘‘Based on the FY 2019
claims, we would estimate that IPF
outlier payments as a percentage of total
IPF payments are 1.9 percent in FY
2021.’’ The correct percentage should be
2.1 percent.
On page 42675, in the second column,
in the first full paragraph, we
incorrectly stated that ‘‘Based on the FY
2019 claims, the estimated change in
total IPF payments for FY 2022 would
include an approximate 0.1 percent
increase in payments because we would
expect the outlier portion of total
payments to increase from
approximately 1.9 percent to 2.0
percent.’’ This should be corrected to
reflect that the estimated change in total
IPF payments for FY 2022 would
include an approximate 0.1 percent
decrease in payments because we would
expect the outlier portion of total
payments to decrease from
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approximately 2.1 percent to 2.0
percent.
On page 42675, in the second column,
in the second full paragraph and
continuing into the first paragraph of
the third column, we incorrectly stated
the overall impact and the impact to
certain provider types due to updating
the outlier fixed dollar loss threshold
amount. We stated that the overall
impact across all hospital groups is an
increase of 0.1 percent, however the
overall impact is actually a decrease of
0.1 percent. We also stated that ‘‘the
largest increase in payments due to this
change is estimated to be 0.4 percent for
teaching IPFs with more than 30 percent
interns and residents to beds.’’ This
should be corrected to reflect that the
largest decreases in payments are
estimated to be 0.4 percent for urban
government IPF units and 0.4 percent
for teaching IPFs with more than 30
percent interns and residents to beds.
On page 42676, in the first column, in
the first full paragraph, we incorrectly
stated that ‘‘The average estimated
increase for all IPFs is approximately
2.1 percent based on the FY 2019
claims,’’ and that this overall increase
includes ‘‘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.’’ These
statements should be corrected to reflect
that the average estimated increase for
all IPFs is approximately 1.9 percent,
and that this includes the overall
estimated 0.1 percent decrease in
estimated IPF outlier payments as a
percent of total payments from updating
the outlier fixed dollar loss threshold
amount.
On page 42676, in the second column,
in the first full paragraph, we
incorrectly stated that ‘‘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.’’ It is
still correct that IPFs are estimated to
experience a net increase in payments
as a result of the updated in this final
rule, however these statements should
be corrected to reflect that IPF payments
are estimated to increase by 1.8 percent
in urban areas and 2.1 percent in rural
areas, and that the largest increases are
estimated at 2.5 percent for IPFs in the
South Atlantic region and 2.5 percent
for rural, government-owned IPF
hospitals.
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On page 42677, in the third column,
in the first full paragraph, we
incorrectly stated that the number of
IPFs with data available in the PSF and
with claims in our FY 2019 MedPAR
claims dataset was 1,519. The correct
number should be 1,520.
On page 42677, Table 19 incorrectly
states that the estimate of annualized
monetized transfers from the federal
government to IPF Medicare providers
is $80 million. This table should be
corrected to reflect that the estimate of
annualized monetized transfers from the
federal government to IPF Medicare
providers is $70 million.
On page 42677, under F. Regulatory
Flexibility Act, in the third column, in
line 10, we incorrectly stated that the
number of IPFs in our database is 1,519.
The correct number of IPFs in our
database is 1,520.
B. Summary of Errors and Corrections to
the IPF PPS Addenda Posted on the
CMS Website
In Addendum A of the FY 2022 IPF
PPS final rule, we have corrected the
outlier fixed dollar loss threshold
amount from $14,470 to $16,040 on the
CMS website at: https://www.cms.gov/
Medicare/Medicare-Fee-for-ServicePayment/InpatientPsychFacilPPS/tools.
III. Waiver of Proposed Rulemaking
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register to provide a period for public
comment before the provisions of a rule
take effect in accordance with section
553(b) of the Administrative Procedure
Act (APA) (5 U.S.C. 553(b)). However,
we can waive this notice and comment
procedure if the Secretary finds, for
good cause, that the notice and
comment process is impracticable,
unnecessary, or contrary to the public
interest, and incorporates a statement of
the finding and the reasons therefore in
the rule.
Section 553(d) of the APA ordinarily
requires a 30-day delay in effective date
of final rules after the date of their
publication in the Federal Register.
This 30-day delay in effective date can
be waived, however, if an agency finds
for good cause that the delay is
impracticable, unnecessary, or contrary
to the public interest, and the agency
incorporates a statement of the findings
and its reasons in the rule issued.
We believe that this correcting
document does not constitute a rule that
would be subject to the notice and
comment or delayed effective date
requirements. This document corrects
technical and typographic errors in the
preamble of the FY 2022 IPF PPS final
rule, but does not make substantive
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Federal Register / Vol. 86, No. 189 / Monday, October 4, 2021 / Rules and Regulations
changes to the policies or payment
methodologies that were adopted in the
final rule. As a result, this correcting
document is intended to ensure that the
information in the FY 2022 IPF PPS
final rule accurately reflects the policies
adopted in that document.
In addition, even if this were a rule to
which the notice and comment
procedures and delayed effective date
requirements applied, we find that there
is good cause to waive such
requirements. Undertaking further
notice and comment procedures to
incorporate the corrections in this
document into the final rule or delaying
the effective date would be contrary to
the public interest because it is in the
public’s interest for IPFs to receive
appropriate payments in as timely a
manner as possible, and to ensure that
the FY 2022 IPF PPS final rule
accurately reflects our policies as of the
date they take effect and are applicable.
Furthermore, such procedures would be
unnecessary, as we are not altering our
payment methodologies or policies, but
rather, we are simply correctly
implementing the policies that we
previously proposed, received comment
on, and subsequently finalized. This
correcting document is intended solely
to ensure that the FY 2022 IPF PPS final
rule accurately reflects these payment
methodologies and policies. For these
reasons, we believe we have good cause
to waive the notice and comment and
effective date requirements. Moreover,
even if these corrections were
considered to be retroactive rulemaking,
they would be authorized under section
1871(e)(1)(A)(ii) of the Act, which
permits the Secretary to issue a rule for
the Medicare program with retroactive
effect if the failure to do so would be
contrary to the public interest. As we
have explained previously, we believe it
would be contrary to the public interest
not to implement the corrections in this
correcting document because it is in the
public’s interest for IPFs to receive
appropriate payments in as timely a
manner as possible, and to ensure that
the FY 2022 IPF PPS final rule
accurately reflects our policies.
IV. Correction of Errors
In FR Doc. 2021–16336 of August 4,
2021 (86 FR 42608), make the following
corrections:
1. On page 42608, in the third
column, second bullet, seventh subbullet, in line 2, remove the number
‘‘$14,470’’ and add in its place
‘‘$16,040’’.
2. On page 42609, in first row of the
table, in the right column, remove ‘‘$80
million’’ and add in its place ‘‘$70
million’’.
3. On page 42623, in the third
column, in the third full paragraph,
a. In line 21, remove ‘‘$1.9 percent’’
and add in its place ‘‘2.1 percent’’.
b. In line 23, remove the number
‘‘$14,470’’ and add in its place
‘‘$16,040’’.
4. On page 42623, in the third
column, in the third full paragraph, in
line 27, remove the word ‘‘decrease’’
and add in its place ‘‘increase’’.
5. On page 42634, in the second
column; in line 3 from the bottom of the
page, in footnote 93, remove the words
‘‘Accessed on 7/6/2021’’ and add in
their place ‘‘Accessed on 7/16/2021’’.
6. On page 42645, in the second
column; in the first full paragraph, in
54633
line 6 and 7, remove the words ‘‘is this
measure’s objective’’ and add in their
place ‘‘is not this measure’s primary
objective’’.
7. On page 42647, in the second
column; in footnote 154, revise the
citation to read as follows, ‘‘Nemani et
al., Association of Psychiatric Disorders
With Mortality Among Patients With
COVID–19, JAMA Psychiatry.
2021;78(4):380–386. doi:10.1001/
jamapsychiatry.2020.4442; COVID–19
and people at increased risk, CDC,
https://www.cdc.gov/drugoverdose/
resources/covid-drugs-QA.html; U.
Saengow et al., Alcohol: A probable risk
factor of COVID–19 severity, 7–20–2021.
doi:10.1111/add.15194’’.
8. On page 42649, in the third
column; the first full paragraph, the
20th line from the top of the page,
remove the words ‘‘a comprehensive
program to address topped out’’ and add
in their place ‘‘a comprehensive
program to address tobacco use’’.
9. On page 42657, in the second
column; the last paragraph under ‘‘b.
Updated Reference to QualityNet
Administrator in the Code of Federal
Regulations’’, the 32nd line from the top
of the page, remove the words ‘‘We are
finalizing our proposal to no longer
require facilities to replace the term
‘QualityNet system administrator’ with
‘‘QualityNet security official’ at
§ 412.434(b)(3) as proposed’’ and add in
their place ‘‘We are finalizing our
proposal to replace the term ‘QualityNet
system administrator’ with ‘‘QualityNet
security official’ at § 412.434(b)(3) as
proposed.’’
10. On page 42659, revise Table 7 to
read as follows:
TABLE 7—PATIENT-LEVEL DATA SUBMISSION REQUIREMENTS FOR CY 2014 IPFQR PROGRAM MEASURE SET
Patient-level data
submission
NQF No.
Measure ID
Measure
0640 .................
0641 .................
0560 .................
HBIPS–2 ..................................
HBIPS–3 ..................................
HBIPS–5 ..................................
0576 .................
N/A * .................
FUH .........................................
SUB–2 and SUB–2a ................
N/A * .................
SUB–3 and SUB–3a ................
N/A * .................
TOB–2 and TOB–2a ................
N/A * .................
TOB–3 and TOB–3a ................
1659 .................
N/A * .................
IMM–2 ......................................
N/A ...........................................
N/A ...................
2860 .................
N/A ...........................................
N/A ...........................................
Hours of Physical Restraint Use ................................................
Hours of Seclusion Use .............................................................
Patients Discharged on Multiple Antipsychotic Medications
with Appropriate Justification.
Follow-Up After Hospitalization for Mental Illness .....................
Alcohol Use Brief Intervention Provided or Offered and SUB–
2a Alcohol Use Brief Intervention.
Alcohol and Other Drug Use Disorder Treatment Provided or
Offered at Discharge and SUB–3a Alcohol and Other Drug
Use Disorder Treatment at Discharge.
Tobacco Use Treatment Provided or Offered and TOB–2a Tobacco Use Treatment.
Tobacco Use Treatment Provided or Offered at Discharge and
TOB–3a Tobacco Use Treatment at Discharge.
Influenza Immunization ..............................................................
Transition Record with Specified Elements Received by Discharged Patients (Discharges from an Inpatient Facility to
Home/Self Care or Any Other Site of Care).
Screening for Metabolic Disorders ............................................
Thirty-Day All-Cause Unplanned Readmission Following Psychiatric Hospitalization in an Inpatient Psychiatric Facility.
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04OCR1
Yes, numerator only.
Yes, numerator only.
Yes.
No (claims-based).
Yes.
Yes.
Yes.
Yes.
Yes.
Yes.
Yes.
No (claims-based).
54634
Federal Register / Vol. 86, No. 189 / Monday, October 4, 2021 / Rules and Regulations
TABLE 7—PATIENT-LEVEL DATA SUBMISSION REQUIREMENTS FOR CY 2014 IPFQR PROGRAM MEASURE SET—
Continued
Patient-level data
submission
NQF No.
Measure ID
Measure
3205 .................
Med Cont .................................
TBD ..................
COVID HCP .............................
Medication Continuation Following Inpatient Psychiatric Discharge.
COVID–19 Healthcare Personnel (HCP) Vaccination Measure
No (claims-based).
No (calculated for HCP).
* Measure is no longer endorsed by the NQF but was endorsed at time of adoption. Section 1886(s)(4)(D)(ii) of the Act authorizes the Secretary to specify a measure that is not endorsed by the NQF as long as due consideration is given to measures that have been endorsed or
adopted by a consensus organization identified by the Secretary. We attempted to find available measures for each of these clinical topics that
have been endorsed or adopted by a consensus organization and found no other feasible and practical measures on the topics for the IPF
setting.
11. On page 42661, in the third
column; in the last paragraph under V.
Collection of Information Requirements,
the 8th line from the bottom of the page,
remove the sentence ‘‘We have not
made any changes from what was
proposed’’ and add in its place ‘‘We
have updated these estimates based on
NQF No.
Measure ID
Measure description
0576 ........
FUH ...................
0648 ........
N/A ....................
Follow-Up After Hospitalization for
Mental Illness *.
Timely Transmission of Transition
Record (Discharges from an Inpatient Facility to Home/Self Care or
Any Other Site of Care).
Total
...........................
the proposals finalized in this final
rule’’.
12. On page 42669, revise Table 15 to
read as follows.
Estimated
cases
(per facility)
Time per case
(hours)
Annual time
per facility
(hours)
0
0 ....................
0
1,634
0
0
(609)
0.25 ...............
152.25
1,634
(248,776.5)
(10,199,836.50)
(609)
Varies ...........
152.25
1,634
(248,776.5)
(10,199,836.50)
.............................................................
Total annual
time
(hours)
Number
IPFs **
Total annual
cost
($)
* CMS will collect these data using Medicare Part A and Part B claims; therefore, these measures will not require facilities to submit data on any cases.
** We note that the previously approved number of IPFs is 1,679; however, we adjusted that in Table 12 based on updated data.
*** At $41.00/hr.
13. On page 42672, below Table 15, in
the second column, in the second full
paragraph, remove the paragraph,
‘‘We estimate that the total impact of
these changes for FY 2022 payments
compared to FY 2021 payments will be
a net increase of approximately $80
million. This reflects an $75 million
increase from the update to the payment
rates (+$100 million from the 2nd
quarter 2021 IGI forecast of the 2016based IPF market basket of 2.7 percent,
and ¥$25 million for the productivity
adjustment of 0.7 percentage point), as
well as a $5 million increase as a result
of the update to the outlier threshold
amount. Outlier payments are estimated
to change from 1.9 percent in FY 2021
to 2.0 percent of total estimated IPF
payments in FY 2022.’’
and add in its place
‘‘We estimate that the total impact of
these changes for FY 2022 payments
compared to FY 2021 payments will be
a net increase of approximately $70
million. This reflects a $75 million
increase from the update to the payment
rates (+$100 million from the 2nd
quarter 2021 IGI forecast of the 2016based IPF market basket of 2.7 percent,
and ¥$25 million for the productivity
adjustment of 0.7 percentage point), as
well as a $5 million decrease as a result
of the update to the outlier threshold
amount. Outlier payments are estimated
to change from 2.1 percent in FY 2021
to 2.0 percent of total estimated IPF
payments in FY 2022.’’
14. On page 42672 in the third
column, in the fourth full paragraph,
a. In line 2, remove ‘‘$80 million’’ and
add in its place ‘‘$70 million’’.
b. In line 6, remove the word
‘‘increase’’ and add in its place
‘‘decrease’’.
15. On pages 42674 and 42675, revise
Table 18 to read as follows:
TABLE 18—FY 2022 IPF PPS FINAL PAYMENT IMPACTS
[Percent change in columns 3 through 5]
Number of
facilities
Outlier
FY 2022 wage index,
LRS, and COLA
Total percent
change 1
Facility by type
FY 2019
claims
(1)
(2)
All Facilities .......................................................................................
Total Urban .......................................................................................
Urban unit ..................................................................................
Urban hospital ............................................................................
Total Rural .........................................................................................
Rural unit ....................................................................................
Rural hospital .............................................................................
By Type of Ownership:
Freestanding IPFs:
Urban Psychiatric Hospitals:
Government .................................................................
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claims
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FY 2019
claims
FY 2020
claims
(3)
FY 2019
claims
FY 2020
claims
(4)
FY 2019
claims
FY 2020
claims
(5)
1,520
1,221
740
481
299
239
60
1,534
1,235
737
498
299
238
61
¥0.1
¥0.1
¥0.2
0.0
¥0.1
¥0.1
¥0.1
¥1.1
¥1.1
¥1.8
¥0.3
¥0.7
¥0.8
¥0.4
0.0
0.0
¥0.1
0.0
0.2
0.1
0.4
0.0
0.0
¥0.1
0.0
0.2
0.1
0.4
1.9
1.8
1.7
2.0
2.1
2.0
2.3
0.9
0.8
0.1
1.7
1.5
1.3
2.0
116
123
¥0.2
¥1.7
¥0.2
¥0.2
1.6
0.1
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Federal Register / Vol. 86, No. 189 / Monday, October 4, 2021 / Rules and Regulations
TABLE 18—FY 2022 IPF PPS FINAL PAYMENT IMPACTS—Continued
[Percent change in columns 3 through 5]
Number of
facilities
Outlier
FY 2022 wage index,
LRS, and COLA
Total percent
change 1
Facility by type
FY 2019
claims
Non-Profit .....................................................................
For-Profit ......................................................................
Rural Psychiatric Hospitals:
Government .................................................................
Non-Profit .....................................................................
For-Profit ......................................................................
IPF Units:
Urban:
Government .................................................................
Non-Profit .....................................................................
For-Profit ......................................................................
Rural:
Government .................................................................
Non-Profit .....................................................................
For-Profit ......................................................................
By Teaching Status:
Non-teaching ..............................................................................
Less than 10% interns and residents to beds ...........................
10% to 30% interns and residents to beds ...............................
More than 30% interns and residents to beds ..........................
By Region:
New England ..............................................................................
Mid-Atlantic ................................................................................
South Atlantic .............................................................................
East North Central .....................................................................
East South Central .....................................................................
West North Central ....................................................................
West South Central ....................................................................
Mountain ....................................................................................
Pacific .........................................................................................
By Bed Size:
Psychiatric Hospitals:
Beds: 0–24 ..........................................................................
Beds: 25–49 ........................................................................
Beds: 50–75 ........................................................................
Beds: 76 + ..........................................................................
Psychiatric Units:
Beds: 0–24 ..........................................................................
Beds: 25–49 ........................................................................
Beds: 50–75 ........................................................................
Beds: 76 + ..........................................................................
FY 2020
claims
FY 2019
claims
FY 2020
claims
FY 2019
claims
FY 2020
claims
FY 2019
claims
FY 2020
claims
95
270
97
278
¥0.1
0.0
¥0.5
¥0.1
¥0.2
0.1
¥0.1
0.1
1.8
2.1
1.4
2.0
31
12
17
32
12
17
¥0.1
¥0.1
0.0
¥0.8
¥1.2
0.0
0.5
¥0.1
0.4
0.6
0.0
0.4
2.5
1.8
2.4
1.8
0.7
2.4
108
480
152
107
478
152
¥0.4
¥0.2
¥0.1
¥3.4
¥1.7
¥0.7
0.1
¥0.1
¥0.1
0.1
¥0.1
¥0.1
1.8
1.7
1.8
¥1.4
0.2
1.2
58
132
49
57
131
50
0.0
¥0.1
¥0.1
¥0.4
¥1.0
¥0.6
0.4
0.1
¥0.2
0.3
0.1
¥0.2
2.3
1.9
1.7
1.9
1.0
1.2
1,322
109
67
22
1,336
109
67
22
¥0.1
¥0.2
¥0.3
¥0.4
¥0.8
¥1.9
¥2.4
¥3.2
0.0
0.1
¥0.1
¥0.1
0.0
0.1
¥0.1
¥0.1
1.9
1.9
1.6
1.5
1.1
0.2
¥0.5
¥1.3
106
215
240
243
152
108
224
103
129
106
216
243
244
155
109
227
103
131
¥0.2
¥0.2
¥0.1
¥0.1
¥0.1
¥0.2
¥0.1
¥0.1
¥0.2
¥1.2
¥2.0
¥0.7
¥0.7
¥0.7
¥1.4
¥0.5
¥0.7
¥1.4
¥0.4
¥0.2
0.6
¥0.2
¥0.5
0.1
¥0.3
0.2
0.4
¥0.4
¥0.2
0.6
¥0.2
¥0.5
0.1
¥0.3
0.3
0.4
1.5
1.6
2.5
1.7
1.4
2.0
1.7
2.2
2.3
0.3
¥0.2
1.9
1.0
0.7
0.7
1.3
1.6
1.0
83
79
84
295
88
83
88
300
¥0.1
0.0
0.0
0.0
¥0.5
¥0.2
¥0.1
¥0.4
0.1
¥0.3
0.1
0.1
0.0
¥0.3
0.2
0.1
2.0
1.7
2.1
2.1
1.5
1.5
2.2
1.7
536
259
114
70
531
259
114
71
¥0.2
¥0.2
¥0.2
¥0.3
¥1.2
¥1.3
¥2.0
¥2.5
0.0
0.0
¥0.3
0.0
0.0
0.0
¥0.3
0.0
1.8
1.9
1.5
1.8
0.7
0.7
¥0.3
¥0.5
1 This column includes the impact of the updates in columns (3) and (4) above, and of the final IPF market basket increase factor for FY 2022 (2.7 percent), reduced by 0.7 percentage point for the productivity adjustment as required by section 1886(s)(2)(A)(i) of the Act. Note, the products of these impacts may be different
from the percentage changes shown here due to rounding effects.
16. On page 42675 in the first column,
in the second full paragraph,
a. In line 2, remove the number
‘‘1,519’’ and add in its place ‘‘1,520’’.
b. In line 6, remove ‘‘1.9 percent’’ and
add in its place ‘‘2.1 percent’’.
17. On page 42675, in the second
column,
a. In the first full paragraph,
(1) In line 5, remove the sentence,
‘‘Based on the FY 2019 claims, the
estimated change in total IPF payments
for FY 2022 would include an
approximate 0.1 percent increase in
payments because we would expect the
outlier portion of total payments to
increase from approximately 1.9 percent
to 2.0 percent.’’
and add in its place,
‘‘Based on the FY 2019 claims, the
estimated change in total IPF payments
for FY 2022 would include an
approximate 0.1 percent decrease in
VerDate Sep<11>2014
16:13 Oct 01, 2021
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payments because we would expect the
outlier portion of total payments to
decrease from approximately 2.1
percent to 2.0 percent.’’
(2) In the second full paragraph and
continuing into the first paragraph of
the third column, remove the paragraph,
‘‘The overall impact of the estimated
increase or decrease to payments due to
updating the outlier fixed dollar loss
threshold (as shown in column 3 of Table
18), across all hospital groups, is 0.1 percent
based on the FY 2019 claims, or ¥1.1
percent based on the FY 2020 claims. Based
on the FY 2019 claims, the largest increase
in payments due to this change is estimated
to be 0.4 percent for teaching IPFs with more
than 30 percent interns and residents to beds.
Among teaching IPFs, this same provider
facility type would experience the largest
estimated decrease in payments if we were to
instead increase the outlier fixed dollar loss
threshold based on the FY 2020 claims
distribution.’’
and add in its place
PO 00000
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‘‘The overall impact of the estimated
decrease to payments due to updating the
outlier fixed dollar loss threshold (as shown
in column 3 of Table 18), across all hospital
groups, is a 0.1 percent decrease based on the
FY 2019 claims, or a 1.1 percent decrease
based on the FY 2020 claims. Based on the
FY 2019 claims, the largest decreases in
payments due to this change are estimated to
be 0.4 percent for urban government IPF
units and 0.4 percent for teaching IPFs with
more than 30 percent interns and residents
to beds. These same provider facility types
would also experience the largest estimated
decreases in payments if we were to instead
increase the outlier fixed dollar loss
threshold based on the FY 2020 claims
distribution.’’
18. On page 42676,
a. In the first column, in the first full
paragraph, remove the paragraph,
‘‘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
E:\FR\FM\04OCR1.SGM
04OCR1
54636
Federal Register / Vol. 86, No. 189 / Monday, October 4, 2021 / Rules and Regulations
and add in its place
these changes). The average estimated
increase for all IPFs is approximately 1.9
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 2016-based IPF market basket update of
2.7 percent reduced by the productivity
adjustment of 0.7 percentage point, as
required by section 1886(s)(2)(A)(i) of the
Act. They also include the overall estimated
0.1 percent decrease 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 laborrelated 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.’’
‘‘Finally, column 5 compares the total final
changes reflected in this final rule for FY
2022 to the estimates for FY 2021 (without
b. In the second column, in the first
full paragraph, remove the paragraph,
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 2016-based market basket update of 2.7
percent reduced by the productivity
adjustment of 0.7 percentage point, as
required by section 1886(s)(2)(A)(i) 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 laborrelated 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.’’
‘‘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.’’
and add in its place
‘‘IPF payments are therefore estimated to
increase by 1.8 percent in urban areas and 2.1
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 increases are estimated at 2.5
percent for IPFs in the South Atlantic region
and 2.5 percent for rural, government-owned
IPF hospitals.’’
19. On page 42677,
a. Above Table 15, in the third
column, in the first full paragraph, in
line 13, remove the number ‘‘1,519’’ and
add in its place ‘‘1,520’’.
b. Revise Table 19 to read as follows:
TABLE 19—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED COSTS, SAVINGS, AND TRANSFERS
Primary
estimate
($million/year)
Category
Regulatory Review Costs ..................
Annualized Monetized Costs Savings
0.2
¥0.51
¥0.44
70
Annualized Monetized Transfers
from Federal Government to IPF
Medicare Providers.
c. Below Table 19, in the third
column, in line 10, remove the number
‘‘1,519’’ and add in its place ‘‘1,520’’.
Karuna Seshasai,
Executive Secretary to the Department,
Department of Health and Human Services.
[FR Doc. 2021–21546 Filed 9–30–21; 4:15 pm]
BILLING CODE 4120–01–P
Units
Low estimate
High estimate
........................
¥0.38
¥0.33
........................
........................
¥0.64
¥0.54
........................
Management (BLM) mineral resources
regulations for the processing of certain
minerals program-related actions. It also
adjusts certain filing fees for mineralsrelated documents. These updated fees
include those for actions such as lease
renewals and mineral patent
adjudications.
This final rule is effective on
October 4, 2021.
DATES:
DEPARTMENT OF THE INTERIOR
You may send inquiries or
suggestions to Director (630), Bureau of
Land Management, 760 Horizon Drive,
Grand Junction, CO 81506; Attention:
RIN 1004–AE81.
ADDRESSES:
Bureau of Land Management
43 CFR Part 3000
[212L1109AF.LLHQ300000.
L13100000.PP0000]
FOR FURTHER INFORMATION CONTACT:
RIN 1004–AE81
Minerals Management: Adjustment of
Cost Recovery Fees
Bureau of Land Management,
Interior.
ACTION: Final rule.
AGENCY:
This final rule updates the
fees set forth in the Bureau of Land
SUMMARY:
VerDate Sep<11>2014
16:13 Oct 01, 2021
Jkt 256001
Sheila Mallory, Acting Chief, Division
of Fluid Minerals, 775–287–3293,
smallory@blm.gov; Lindsey Curnutt,
Chief, Division of Solid Minerals, 775–
824–2910, lcurnutt@blm.gov; or Faith
Bremner, Regulatory Analyst, Division
of Regulatory Affairs, fbremner@
blm.gov. Persons who use a
telecommunications device for the deaf
(TDD) may leave a message for these
individuals with the Federal Relay
PO 00000
Discount rate
(%)
Year dollars
Frm 00050
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2020
2019
2019
FY 2022
........................
7
3
........................
Period covered
FY
FY
FY
FY
2022.
2023–FY 2031.
2023–FY 2031.
2022.
Service (FRS) at 1–800–877–8339, 24
hours a day, 7 days a week.
SUPPLEMENTARY INFORMATION:
I. Background
The BLM has authority to charge fees
for processing applications and other
documents relating to public lands
under section 304 of the Federal Land
Policy and Management Act of 1976
(FLPMA), 43 U.S.C. 1734. In 2005, the
BLM published a final cost recovery
rule (70 FR 58854) that established new
fees or revised fees and service charges
for processing documents related to its
minerals programs (‘‘2005 Cost
Recovery Rule’’). In addition, the 2005
Cost Recovery Rule also established the
method the BLM would use to adjust
those fees and service charges for
inflation on an annual basis.
The regulations at 43 CFR 3000.12(a)
provide that the BLM will annually
adjust fees established in subchapter C
(43 CFR parts 3000–3900) according to
changes in the Implicit Price Deflator for
Gross Domestic Product (IPD–GDP),
which is published quarterly by the U.S.
E:\FR\FM\04OCR1.SGM
04OCR1
]]>Agencies
[Federal Register Volume 86, Number 189 (Monday, October 4, 2021)]
[Rules and Regulations]
[Pages 54631-54636]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-21546]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 412
[CMS-1750-CN]
RIN 0938-AU40
Medicare Program; Fiscal Year (FY) 2022 Inpatient Psychiatric
Facilities Prospective Payment System and Quality Reporting Updates for
Fiscal Year Beginning October 1, 2021 (FY 2022); Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical errors that appeared in the
final rule published in the Federal Register on August 4, 2021 entitled
``Medicare Program; FY 2022 Inpatient Psychiatric Facilities
Prospective Payment System and Quality Reporting Updates for Fiscal
Year Beginning October 1, 2021 (FY 2022)''.
DATES: This correction is effective October 1, 2021.
FOR FURTHER INFORMATION CONTACT:
Lauren Lowenstein, (410) 786-4507 for information regarding the
Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program.
The IPF Payment Policy mailbox at [email protected] for
general information.
Nicolas Brock, (410) 786-5148 or Theresa Bean (410) 786-2287, for
information regarding the outlier fixed dollar loss threshold amount
and the regulatory impact analysis.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2021-16336 of August 4, 2021 (86 FR 42608), there were a
number of technical errors that are identified and corrected in this
correcting document. The provisions in this correction document are
effective as if they had been included in the document published on
August 4, 2021. Accordingly, the corrections are effective October 1,
2021.
II. Summary of Errors
A. Summary of Errors in the Preamble
1. Inpatient Psychiatric Facilities Prospective Payment System (IPF
PPS) Corrections
There was a technical error in the simulation of Inpatient
Psychiatric Facilities (IPF) payments that affected the impact analysis
and the calculation of the final outlier fixed dollar loss threshold
amount. In estimating the percentage of outlier payments as a
percentage of total payments, we inadvertently applied provider
information from the January, 2021 update of the Provider-Specific File
(PSF) instead of the most recently available update from April, 2021.
For fiscal year (FY) 2022, we finalized our proposal to update the IPF
outlier threshold amount using FY 2019 claims data and the same
methodology that we used to set the initial outlier threshold amount in
the Rate Year 2007 IPF PPS final rule (71 FR 27072 and 27073). In
accordance with that longstanding methodology, the calculation of
estimated outlier payments should have used the April, 2021 provider
information rather than the January, 2021 provider information.
As a result of the error in estimating outlier payments, the FY
2022 IPF PPS final rule overstated the estimate of increased transfers
from the federal government to IPF providers. We estimated $80 million
in increased transfers from the federal government to IPF providers;
however, based on the corrected calculation of the outlier fixed dollar
loss threshold amount, the correct estimate of increased transfers from
the federal government to IPF providers should be $70 million. Also, as
a result of the error in estimating outlier payments, the FY 2022 IPF
PPS final rule incorrectly estimated and described the impact of the
final rule on various provider types and the total number of providers
included in the analysis.
On page 42608, in the third column, second bullet, seventh sub-
bullet, the fixed dollar loss threshold amount should be changed from
``$14,470'' to ``$16,040''.
On page 42609, the table summarizing Total Transfers and Cost
reductions should reflect the corrected estimate of increased payments
to IPFs during FY 2022, which should be corrected from $80 million to
$70 million.
On page 42623, in the third column, in the third full paragraph, we
incorrectly stated that IPF outlier payments as a percentage of total
estimated payments were approximately 1.9 percent in FY 2021. The
correct percentage should be 2.1 percent.
On page 42623, in the third column, in the third full paragraph, we
incorrectly stated that we were decreasing the outlier threshold amount
to $14,470. The correct update to the outlier threshold amount should
be increased to $16,040.
2. Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program
Corrections
On page 42634, in footnote 93, we made a typographical error and
listed the date information was accessed as July 6 instead of July 16.
On page 42645, in the second column in the first full paragraph, we
inadvertently omitted several words from the phrase ``is this measure's
objective'' which should read ``is not this measure's primary
objective''.
On page 42647, in footnote 154, we inadvertently omitted the end of
the footnote, which should read, ``., Alcohol: A probable risk factor
of COVID-19 severity, 7-20-2021. doi:10.1111/add.15194''.
On page 42649, in the third column, in the first full paragraph, we
made a typographical error and referred to ``a comprehensive program to
address topped out'' instead of ``a comprehensive program to address
tobacco use''.
On page 42657, in the last paragraph under subsection b, we
inadvertently included the phrase ``to no longer require facilities. .
.''.
On page 42659, in Table 7, we inadvertently included the ``Timely
Transmission of Transition Record (Discharges from an Inpatient
Facility to Home/Self Care or any Other Site of Care)'' in the table.
On page 42661, in the last paragraph, last sentence, under V.
Collection of Information Requirements, we inadvertently stated ``We
have not made any changes from what was proposed.''
On page 42669, in Table 15, we made a typographical error and
listed the annual cost update for the removal of the Timely
Transmission of Transition Record (Discharges from an Inpatient
Facility to Home/Self Care or Any Other Site of Care) and the total
cost update as (10,199,836.5050) instead of (10,199,836.50).
3. Regulatory Impact Analysis Corrections
On page 42672, in the second column, we incorrectly stated that
``we estimate that the total impact of these changes for FY 2022
payments compared to FY 2021
[[Page 54632]]
payments will be a net increase of approximately $80 million. This
reflects an $75 million increase from the update to the payment rates
(+$100 million from the 2nd quarter 2021 IGI forecast of the 2016-based
IPF market basket of 2.7 percent, and -$25 million for the productivity
adjustment of 0.7 percentage point), as well as a $5 million increase
as a result of the update to the outlier threshold amount. Outlier
payments are estimated to change from 1.9 percent in FY 2021 to 2.0
percent of total estimated IPF payments in FY 2022''. This paragraph
should be revised to reflect that outlier payments are estimated to
change from 2.1 percent in FY 2021 to 2.0 percent in FY 2022, and that
the update to the outlier threshold will result in a $5 million
decrease and a net increase of approximately $70 million in FY 2022
payments.
On page 42672 in the third column, in the fourth full paragraph
under C. Detailed Economic Analysis, ``$80 million'' should be replaced
with ``$70 million'' and ``$5 million increase'' should be replaced
with ``$5 million decrease''.
On pages 42674 and 42675, Table 18 reflects the impact to providers
of updating the outlier fixed dollar loss threshold amount based on the
inaccurate calculation of estimated FY 2021 outlier payments;
therefore, Table 18 should be updated to reflect the correct
calculations.
On page 42675 in the first column, in the second full paragraph
under 3. Impact Results, we incorrectly stated that the number of IPFs
included in the analysis for FY 2019 claims is 1,519. The correct
number is 1,520 IPFs.
On page 42675, in the first column, in the third full paragraph, we
incorrectly stated that ``Based on the FY 2019 claims, we would
estimate that IPF outlier payments as a percentage of total IPF
payments are 1.9 percent in FY 2021.'' The correct percentage should be
2.1 percent.
On page 42675, in the second column, in the first full paragraph,
we incorrectly stated that ``Based on the FY 2019 claims, the estimated
change in total IPF payments for FY 2022 would include an approximate
0.1 percent increase in payments because we would expect the outlier
portion of total payments to increase from approximately 1.9 percent to
2.0 percent.'' This should be corrected to reflect that the estimated
change in total IPF payments for FY 2022 would include an approximate
0.1 percent decrease in payments because we would expect the outlier
portion of total payments to decrease from approximately 2.1 percent to
2.0 percent.
On page 42675, in the second column, in the second full paragraph
and continuing into the first paragraph of the third column, we
incorrectly stated the overall impact and the impact to certain
provider types due to updating the outlier fixed dollar loss threshold
amount. We stated that the overall impact across all hospital groups is
an increase of 0.1 percent, however the overall impact is actually a
decrease of 0.1 percent. We also stated that ``the largest increase in
payments due to this change is estimated to be 0.4 percent for teaching
IPFs with more than 30 percent interns and residents to beds.'' This
should be corrected to reflect that the largest decreases in payments
are estimated to be 0.4 percent for urban government IPF units and 0.4
percent for teaching IPFs with more than 30 percent interns and
residents to beds.
On page 42676, in the first column, in the first full paragraph, we
incorrectly stated that ``The average estimated increase for all IPFs
is approximately 2.1 percent based on the FY 2019 claims,'' and that
this overall increase includes ``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.'' These statements should be corrected to reflect that the
average estimated increase for all IPFs is approximately 1.9 percent,
and that this includes the overall estimated 0.1 percent decrease in
estimated IPF outlier payments as a percent of total payments from
updating the outlier fixed dollar loss threshold amount.
On page 42676, in the second column, in the first full paragraph,
we incorrectly stated that ``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.'' It is still correct
that IPFs are estimated to experience a net increase in payments as a
result of the updated in this final rule, however these statements
should be corrected to reflect that IPF payments are estimated to
increase by 1.8 percent in urban areas and 2.1 percent in rural areas,
and that the largest increases are estimated at 2.5 percent for IPFs in
the South Atlantic region and 2.5 percent for rural, government-owned
IPF hospitals.
On page 42677, in the third column, in the first full paragraph, we
incorrectly stated that the number of IPFs with data available in the
PSF and with claims in our FY 2019 MedPAR claims dataset was 1,519. The
correct number should be 1,520.
On page 42677, Table 19 incorrectly states that the estimate of
annualized monetized transfers from the federal government to IPF
Medicare providers is $80 million. This table should be corrected to
reflect that the estimate of annualized monetized transfers from the
federal government to IPF Medicare providers is $70 million.
On page 42677, under F. Regulatory Flexibility Act, in the third
column, in line 10, we incorrectly stated that the number of IPFs in
our database is 1,519. The correct number of IPFs in our database is
1,520.
B. Summary of Errors and Corrections to the IPF PPS Addenda Posted on
the CMS Website
In Addendum A of the FY 2022 IPF PPS final rule, we have corrected
the outlier fixed dollar loss threshold amount from $14,470 to $16,040
on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientPsychFacilPPS/tools.
III. Waiver of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we
can waive this notice and comment procedure if the Secretary finds, for
good cause, that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons therefore in the rule.
Section 553(d) of the APA ordinarily requires a 30-day delay in
effective date of final rules after the date of their publication in
the Federal Register. This 30-day delay in effective date can be
waived, however, if an agency finds for good cause that the delay is
impracticable, unnecessary, or contrary to the public interest, and the
agency incorporates a statement of the findings and its reasons in the
rule issued.
We believe that this correcting document does not constitute a rule
that would be subject to the notice and comment or delayed effective
date requirements. This document corrects technical and typographic
errors in the preamble of the FY 2022 IPF PPS final rule, but does not
make substantive
[[Page 54633]]
changes to the policies or payment methodologies that were adopted in
the final rule. As a result, this correcting document is intended to
ensure that the information in the FY 2022 IPF PPS final rule
accurately reflects the policies adopted in that document.
In addition, even if this were a rule to which the notice and
comment procedures and delayed effective date requirements applied, we
find that there is good cause to waive such requirements. Undertaking
further notice and comment procedures to incorporate the corrections in
this document into the final rule or delaying the effective date would
be contrary to the public interest because it is in the public's
interest for IPFs to receive appropriate payments in as timely a manner
as possible, and to ensure that the FY 2022 IPF PPS final rule
accurately reflects our policies as of the date they take effect and
are applicable. Furthermore, such procedures would be unnecessary, as
we are not altering our payment methodologies or policies, but rather,
we are simply correctly implementing the policies that we previously
proposed, received comment on, and subsequently finalized. This
correcting document is intended solely to ensure that the FY 2022 IPF
PPS final rule accurately reflects these payment methodologies and
policies. For these reasons, we believe we have good cause to waive the
notice and comment and effective date requirements. Moreover, even if
these corrections were considered to be retroactive rulemaking, they
would be authorized under section 1871(e)(1)(A)(ii) of the Act, which
permits the Secretary to issue a rule for the Medicare program with
retroactive effect if the failure to do so would be contrary to the
public interest. As we have explained previously, we believe it would
be contrary to the public interest not to implement the corrections in
this correcting document because it is in the public's interest for
IPFs to receive appropriate payments in as timely a manner as possible,
and to ensure that the FY 2022 IPF PPS final rule accurately reflects
our policies.
IV. Correction of Errors
In FR Doc. 2021-16336 of August 4, 2021 (86 FR 42608), make the
following corrections:
1. On page 42608, in the third column, second bullet, seventh sub-
bullet, in line 2, remove the number ``$14,470'' and add in its place
``$16,040''.
2. On page 42609, in first row of the table, in the right column,
remove ``$80 million'' and add in its place ``$70 million''.
3. On page 42623, in the third column, in the third full paragraph,
a. In line 21, remove ``$1.9 percent'' and add in its place ``2.1
percent''.
b. In line 23, remove the number ``$14,470'' and add in its place
``$16,040''.
4. On page 42623, in the third column, in the third full paragraph,
in line 27, remove the word ``decrease'' and add in its place
``increase''.
5. On page 42634, in the second column; in line 3 from the bottom
of the page, in footnote 93, remove the words ``Accessed on 7/6/2021''
and add in their place ``Accessed on 7/16/2021''.
6. On page 42645, in the second column; in the first full
paragraph, in line 6 and 7, remove the words ``is this measure's
objective'' and add in their place ``is not this measure's primary
objective''.
7. On page 42647, in the second column; in footnote 154, revise the
citation to read as follows, ``Nemani et al., Association of
Psychiatric Disorders With Mortality Among Patients With COVID-19, JAMA
Psychiatry. 2021;78(4):380-386. doi:10.1001/jamapsychiatry.2020.4442;
COVID-19 and people at increased risk, CDC, https://www.cdc.gov/drugoverdose/resources/covid-drugs-QA.html; U. Saengow et al., Alcohol:
A probable risk factor of COVID-19 severity, 7-20-2021. doi:10.1111/
add.15194''.
8. On page 42649, in the third column; the first full paragraph,
the 20th line from the top of the page, remove the words ``a
comprehensive program to address topped out'' and add in their place
``a comprehensive program to address tobacco use''.
9. On page 42657, in the second column; the last paragraph under
``b. Updated Reference to QualityNet Administrator in the Code of
Federal Regulations'', the 32nd line from the top of the page, remove
the words ``We are finalizing our proposal to no longer require
facilities to replace the term `QualityNet system administrator' with
``QualityNet security official' at Sec. 412.434(b)(3) as proposed''
and add in their place ``We are finalizing our proposal to replace the
term `QualityNet system administrator' with ``QualityNet security
official' at Sec. 412.434(b)(3) as proposed.''
10. On page 42659, revise Table 7 to read as follows:
Table 7--Patient-Level Data Submission Requirements for CY 2014 IPFQR Program Measure Set
----------------------------------------------------------------------------------------------------------------
NQF No. Measure ID Measure Patient-level data submission
----------------------------------------------------------------------------------------------------------------
0640........................... HBIPS-2........... Hours of Physical Yes, numerator only.
Restraint Use.
0641........................... HBIPS-3........... Hours of Seclusion Use Yes, numerator only.
0560........................... HBIPS-5........... Patients Discharged on Yes.
Multiple
Antipsychotic
Medications with
Appropriate
Justification.
0576........................... FUH............... Follow-Up After No (claims-based).
Hospitalization for
Mental Illness.
N/A *.......................... SUB-2 and SUB-2a.. Alcohol Use Brief Yes.
Intervention Provided
or Offered and SUB-2a
Alcohol Use Brief
Intervention.
N/A *.......................... SUB-3 and SUB-3a.. Alcohol and Other Drug Yes.
Use Disorder
Treatment Provided or
Offered at Discharge
and SUB-3a Alcohol
and Other Drug Use
Disorder Treatment at
Discharge.
N/A *.......................... TOB-2 and TOB-2a.. Tobacco Use Treatment Yes.
Provided or Offered
and TOB-2a Tobacco
Use Treatment.
N/A *.......................... TOB-3 and TOB-3a.. Tobacco Use Treatment Yes.
Provided or Offered
at Discharge and TOB-
3a Tobacco Use
Treatment at
Discharge.
1659........................... IMM-2............. Influenza Immunization Yes.
N/A *.......................... N/A............... Transition Record with Yes.
Specified Elements
Received by
Discharged Patients
(Discharges from an
Inpatient Facility to
Home/Self Care or Any
Other Site of Care).
N/A............................ N/A............... Screening for Yes.
Metabolic Disorders.
2860........................... N/A............... Thirty-Day All-Cause No (claims-based).
Unplanned Readmission
Following Psychiatric
Hospitalization in an
Inpatient Psychiatric
Facility.
[[Page 54634]]
3205........................... Med Cont.......... Medication No (claims-based).
Continuation
Following Inpatient
Psychiatric Discharge.
TBD............................ COVID HCP......... COVID-19 Healthcare No (calculated for HCP).
Personnel (HCP)
Vaccination Measure.
----------------------------------------------------------------------------------------------------------------
* Measure is no longer endorsed by the NQF but was endorsed at time of adoption. Section 1886(s)(4)(D)(ii) of
the Act authorizes the Secretary to specify a measure that is not endorsed by the NQF as long as due
consideration is given to measures that have been endorsed or adopted by a consensus organization identified
by the Secretary. We attempted to find available measures for each of these clinical topics that have been
endorsed or adopted by a consensus organization and found no other feasible and practical measures on the
topics for the IPF setting.
11. On page 42661, in the third column; in the last paragraph under
V. Collection of Information Requirements, the 8th line from the bottom
of the page, remove the sentence ``We have not made any changes from
what was proposed'' and add in its place ``We have updated these
estimates based on the proposals finalized in this final rule''.
12. On page 42669, revise Table 15 to read as follows.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Annual time
Estimated Time per case per Number IPFs Total Total annual
NQF No. Measure ID Measure description cases (per (hours) facility ** annual time cost ($)
facility) (hours) (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
0576........... FUH................ Follow-Up After 0 0.................. 0 1,634 0 0
Hospitalization for
Mental Illness *.
0648........... N/A................ Timely Transmission of (609) 0.25............... 152.25 1,634 (248,776.5) (10,199,836.50)
Transition Record
(Discharges from an
Inpatient Facility to
Home/Self Care or Any
Other Site of Care).
-----------------------------------------------------------------------------------------
Total...... ................... ........................ (609) Varies............. 152.25 1,634 (248,776.5) (10,199,836.50)
--------------------------------------------------------------------------------------------------------------------------------------------------------
* CMS will collect these data using Medicare Part A and Part B claims; therefore, these measures will not require facilities to submit data on any
cases.
** We note that the previously approved number of IPFs is 1,679; however, we adjusted that in Table 12 based on updated data.
*** At $41.00/hr.
13. On page 42672, below Table 15, in the second column, in the
second full paragraph, remove the paragraph,
``We estimate that the total impact of these changes for FY 2022
payments compared to FY 2021 payments will be a net increase of
approximately $80 million. This reflects an $75 million increase from
the update to the payment rates (+$100 million from the 2nd quarter
2021 IGI forecast of the 2016-based IPF market basket of 2.7 percent,
and -$25 million for the productivity adjustment of 0.7 percentage
point), as well as a $5 million increase as a result of the update to
the outlier threshold amount. Outlier payments are estimated to change
from 1.9 percent in FY 2021 to 2.0 percent of total estimated IPF
payments in FY 2022.''
and add in its place
``We estimate that the total impact of these changes for FY 2022
payments compared to FY 2021 payments will be a net increase of
approximately $70 million. This reflects a $75 million increase from
the update to the payment rates (+$100 million from the 2nd quarter
2021 IGI forecast of the 2016-based IPF market basket of 2.7 percent,
and -$25 million for the productivity adjustment of 0.7 percentage
point), as well as a $5 million decrease as a result of the update to
the outlier threshold amount. Outlier payments are estimated to change
from 2.1 percent in FY 2021 to 2.0 percent of total estimated IPF
payments in FY 2022.''
14. On page 42672 in the third column, in the fourth full
paragraph,
a. In line 2, remove ``$80 million'' and add in its place ``$70
million''.
b. In line 6, remove the word ``increase'' and add in its place
``decrease''.
15. On pages 42674 and 42675, revise Table 18 to read as follows:
Table 18--FY 2022 IPF PPS Final Payment Impacts
[Percent change in columns 3 through 5]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number of Outlier FY 2022 wage index, Total percent
facilities ---------------------- LRS, and COLA change \1\
Facility by type ---------------------- -------------------------------------------
FY 2019 FY 2020 FY 2019 FY 2020 FY 2019 FY 2020 FY 2019 FY 2020
claims claims claims claims claims claims claims claims
--------------------------------------------------------------------------------------------------------------------------------------------------------
(1) (2)
(3)
(4)
(5)
--------------------------------------------------------------------------------------------------------------------------------------------------------
All Facilities.................................................. 1,520 1,534 -0.1 -1.1 0.0 0.0 1.9 0.9
Total Urban..................................................... 1,221 1,235 -0.1 -1.1 0.0 0.0 1.8 0.8
Urban unit.................................................. 740 737 -0.2 -1.8 -0.1 -0.1 1.7 0.1
Urban hospital.............................................. 481 498 0.0 -0.3 0.0 0.0 2.0 1.7
Total Rural..................................................... 299 299 -0.1 -0.7 0.2 0.2 2.1 1.5
Rural unit.................................................. 239 238 -0.1 -0.8 0.1 0.1 2.0 1.3
Rural hospital.............................................. 60 61 -0.1 -0.4 0.4 0.4 2.3 2.0
By Type of Ownership:
Freestanding IPFs:
Urban Psychiatric Hospitals:
Government.......................................... 116 123 -0.2 -1.7 -0.2 -0.2 1.6 0.1
[[Page 54635]]
Non-Profit.......................................... 95 97 -0.1 -0.5 -0.2 -0.1 1.8 1.4
For-Profit.......................................... 270 278 0.0 -0.1 0.1 0.1 2.1 2.0
Rural Psychiatric Hospitals:
Government.......................................... 31 32 -0.1 -0.8 0.5 0.6 2.5 1.8
Non-Profit.......................................... 12 12 -0.1 -1.2 -0.1 0.0 1.8 0.7
For-Profit.......................................... 17 17 0.0 0.0 0.4 0.4 2.4 2.4
IPF Units:
Urban:
Government.......................................... 108 107 -0.4 -3.4 0.1 0.1 1.8 -1.4
Non-Profit.......................................... 480 478 -0.2 -1.7 -0.1 -0.1 1.7 0.2
For-Profit.......................................... 152 152 -0.1 -0.7 -0.1 -0.1 1.8 1.2
Rural:
Government.......................................... 58 57 0.0 -0.4 0.4 0.3 2.3 1.9
Non-Profit.......................................... 132 131 -0.1 -1.0 0.1 0.1 1.9 1.0
For-Profit.......................................... 49 50 -0.1 -0.6 -0.2 -0.2 1.7 1.2
By Teaching Status:
Non-teaching................................................ 1,322 1,336 -0.1 -0.8 0.0 0.0 1.9 1.1
Less than 10% interns and residents to beds................. 109 109 -0.2 -1.9 0.1 0.1 1.9 0.2
10% to 30% interns and residents to beds.................... 67 67 -0.3 -2.4 -0.1 -0.1 1.6 -0.5
More than 30% interns and residents to beds................. 22 22 -0.4 -3.2 -0.1 -0.1 1.5 -1.3
By Region:
New England................................................. 106 106 -0.2 -1.2 -0.4 -0.4 1.5 0.3
Mid-Atlantic................................................ 215 216 -0.2 -2.0 -0.2 -0.2 1.6 -0.2
South Atlantic.............................................. 240 243 -0.1 -0.7 0.6 0.6 2.5 1.9
East North Central.......................................... 243 244 -0.1 -0.7 -0.2 -0.2 1.7 1.0
East South Central.......................................... 152 155 -0.1 -0.7 -0.5 -0.5 1.4 0.7
West North Central.......................................... 108 109 -0.2 -1.4 0.1 0.1 2.0 0.7
West South Central.......................................... 224 227 -0.1 -0.5 -0.3 -0.3 1.7 1.3
Mountain.................................................... 103 103 -0.1 -0.7 0.2 0.3 2.2 1.6
Pacific..................................................... 129 131 -0.2 -1.4 0.4 0.4 2.3 1.0
By Bed Size:
Psychiatric Hospitals:
Beds: 0-24.............................................. 83 88 -0.1 -0.5 0.1 0.0 2.0 1.5
Beds: 25-49............................................. 79 83 0.0 -0.2 -0.3 -0.3 1.7 1.5
Beds: 50-75............................................. 84 88 0.0 -0.1 0.1 0.2 2.1 2.2
Beds: 76 +.............................................. 295 300 0.0 -0.4 0.1 0.1 2.1 1.7
Psychiatric Units:
Beds: 0-24.............................................. 536 531 -0.2 -1.2 0.0 0.0 1.8 0.7
Beds: 25-49............................................. 259 259 -0.2 -1.3 0.0 0.0 1.9 0.7
Beds: 50-75............................................. 114 114 -0.2 -2.0 -0.3 -0.3 1.5 -0.3
Beds: 76 +.............................................. 70 71 -0.3 -2.5 0.0 0.0 1.8 -0.5
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ This column includes the impact of the updates in columns (3) and (4) above, and of the final IPF market basket increase factor for FY 2022 (2.7
percent), reduced by 0.7 percentage point for the productivity adjustment as required by section 1886(s)(2)(A)(i) of the Act. Note, the products of
these impacts may be different from the percentage changes shown here due to rounding effects.
16. On page 42675 in the first column, in the second full
paragraph,
a. In line 2, remove the number ``1,519'' and add in its place
``1,520''.
b. In line 6, remove ``1.9 percent'' and add in its place ``2.1
percent''.
17. On page 42675, in the second column,
a. In the first full paragraph,
(1) In line 5, remove the sentence,
``Based on the FY 2019 claims, the estimated change in total IPF
payments for FY 2022 would include an approximate 0.1 percent increase
in payments because we would expect the outlier portion of total
payments to increase from approximately 1.9 percent to 2.0 percent.''
and add in its place,
``Based on the FY 2019 claims, the estimated change in total IPF
payments for FY 2022 would include an approximate 0.1 percent decrease
in payments because we would expect the outlier portion of total
payments to decrease from approximately 2.1 percent to 2.0 percent.''
(2) In the second full paragraph and continuing into the first
paragraph of the third column, remove the paragraph,
``The overall impact of the estimated increase or decrease to
payments due to updating the outlier fixed dollar loss threshold (as
shown in column 3 of Table 18), across all hospital groups, is 0.1
percent based on the FY 2019 claims, or -1.1 percent based on the FY
2020 claims. Based on the FY 2019 claims, the largest increase in
payments due to this change is estimated to be 0.4 percent for
teaching IPFs with more than 30 percent interns and residents to
beds. Among teaching IPFs, this same provider facility type would
experience the largest estimated decrease in payments if we were to
instead increase the outlier fixed dollar loss threshold based on
the FY 2020 claims distribution.''
and add in its place
``The overall impact of the estimated decrease to payments due
to updating the outlier fixed dollar loss threshold (as shown in
column 3 of Table 18), across all hospital groups, is a 0.1 percent
decrease based on the FY 2019 claims, or a 1.1 percent decrease
based on the FY 2020 claims. Based on the FY 2019 claims, the
largest decreases in payments due to this change are estimated to be
0.4 percent for urban government IPF units and 0.4 percent for
teaching IPFs with more than 30 percent interns and residents to
beds. These same provider facility types would also experience the
largest estimated decreases in payments if we were to instead
increase the outlier fixed dollar loss threshold based on the FY
2020 claims distribution.''
18. On page 42676,
a. In the first column, in the first full paragraph, remove the
paragraph,
``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
[[Page 54636]]
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 2016-based market
basket update of 2.7 percent reduced by the productivity adjustment
of 0.7 percentage point, as required by section 1886(s)(2)(A)(i) 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.''
and add in its place
``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 1.9 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 2016-based IPF market basket update of
2.7 percent reduced by the productivity adjustment of 0.7 percentage
point, as required by section 1886(s)(2)(A)(i) of the Act. They also
include the overall estimated 0.1 percent decrease 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.''
b. In the second column, in the first full paragraph, remove the
paragraph,
``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.''
and add in its place
``IPF payments are therefore estimated to increase by 1.8
percent in urban areas and 2.1 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 increases are estimated at 2.5 percent for IPFs
in the South Atlantic region and 2.5 percent for rural, government-
owned IPF hospitals.''
19. On page 42677,
a. Above Table 15, in the third column, in the first full
paragraph, in line 13, remove the number ``1,519'' and add in its place
``1,520''.
b. Revise Table 19 to read as follows:
Table 19--Accounting Statement: Classification of Estimated Costs, Savings, and Transfers
--------------------------------------------------------------------------------------------------------------------------------------------------------
Primary Units
estimate -----------------------------------------------------------------
Category ($million/ Low estimate High estimate Discount rate
year) Year dollars (%) Period covered
--------------------------------------------------------------------------------------------------------------------------------------------------------
Regulatory Review Costs............... 0.2 .............. .............. 2020 .............. FY 2022.
Annualized Monetized Costs Savings.... -0.51 -0.38 -0.64 2019 7 FY 2023-FY 2031.
-0.44 -0.33 -0.54 2019 3 FY 2023-FY 2031.
Annualized Monetized Transfers from 70 .............. .............. FY 2022 .............. FY 2022.
Federal Government to IPF Medicare
Providers.
--------------------------------------------------------------------------------------------------------------------------------------------------------
c. Below Table 19, in the third column, in line 10, remove the
number ``1,519'' and add in its place ``1,520''.
Karuna Seshasai,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2021-21546 Filed 9-30-21; 4:15 pm]
BILLING CODE 4120-01-P
