Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2022 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Changes to Medicaid Provider Enrollment; and Changes to the Medicare Shared Savings Program; Corrections, 58019-58039 [2021-22724]
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Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
Allison Pompey, (410) 786–2348, New
Technology Add-On Payments Issues.
Julia Venanzi, julia.venanzi@
cms.hhs.gov, Hospital Inpatient Quality
Reporting and Hospital Value-Based
Purchasing Programs.
SUPPLEMENTARY INFORMATION:
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 412, 413, 425, 455, and
495
[CMS–1752–F2 and CMS–1762–F2]
RIN 0938–AU44 and 0938–AU56
Medicare Program; Hospital Inpatient
Prospective Payment Systems for
Acute Care Hospitals and the LongTerm Care Hospital Prospective
Payment System and Policy Changes
and Fiscal Year 2022 Rates; Quality
Programs and Medicare Promoting
Interoperability Program Requirements
for Eligible Hospitals and Critical
Access Hospitals; Changes to
Medicaid Provider Enrollment; and
Changes to the Medicare Shared
Savings Program; Corrections
Centers for Medicare &
Medicaid Services (CMS), Department
of Health and Human Services (HHS).
ACTION: Final rule; correction and
correcting amendment.
AGENCY:
This document corrects
technical and typographical errors in
the final rule that appeared in the
August 13, 2021, issue of the Federal
Register titled ‘‘Medicare Program;
Hospital Inpatient Prospective Payment
Systems for Acute Care Hospitals and
the Long Term Care Hospital
Prospective Payment System and Policy
Changes and Fiscal Year 2022 Rates;
Quality Programs and Medicare
Promoting Interoperability Program
Requirements for Eligible Hospitals and
Critical Access Hospitals; Changes to
Medicaid Provider Enrollment; and
Changes to the Medicare Shared Savings
Program.’’
DATES:
Effective date: The final rule
corrections and correcting amendment
are effective on October 19, 2021.
Applicability date: The final rule
corrections and correcting amendment
are applicable to discharges occurring
on or after October 1, 2021.
FOR FURTHER INFORMATION CONTACT:
Donald Thompson, (410) 786–4487, and
Michele Hudson, (410) 786–4487,
Operating Prospective Payment, Wage
Index, Hospital Geographic
Reclassifications, Medicare
Disproportionate Share Hospital (DSH)
Payment Adjustment, Graduate Medical
Education, and Critical Access Hospital
(CAH) Issues. Mady Hue, (410) 786–
4510, and Andrea Hazeley, (410) 786–
3543, MS–DRG Classification Issues.
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SUMMARY:
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I. Background
In FR Doc. 2021–16519 of August 13,
2021 (86 FR 44774), there were a
number of technical and typographical
errors that are identified and corrected
in this final rule correction and
correcting amendment. The final rule
corrections and correcting amendment
are applicable to discharges occurring
on or after October 1, 2021, as if they
had been included in the document that
appeared in the August 13, 2021,
Federal Register.
II. Summary of Errors
A. Summary of Errors in the Preamble
On page 44878, we are correcting an
inadvertent error in the reference to the
number of technologies for which we
proposed to allow a one-time extension
of new technology add-on payments for
fiscal year (FY) 2022.
On page 44889, we are correcting an
inadvertent typographical error in the
International Classification of Disease,
10th Revision, Procedure Coding
System (ICD–10–PCS) procedure code
describing the percutaneous endoscopic
repair of the esophagus.
On page 44960, in the table displaying
the Medicare-Severity Diagnosis Related
Groups (MS–DRGs) subject to the policy
for replaced devices offered without
cost or with a credit for FY 2022, we are
correcting inadvertent typographical
errors in the MS–DRGs describing Hip
Replacement with Principal Diagnosis
of Hip Fracture with and without MCC,
respectively.
On pages 45047, 45048, and 45049, in
our discussion of the new technology
add-on payments for FY 2022, we are
correcting typographical and technical
errors in referencing sections of the final
rule.
On page 45133, we are correcting an
error in the maximum new technology
add-on payment for a case involving the
use of AprevoTM Intervertebral Body
Fusion Device.
On page 45150, we inadvertently
omitted ICD–10–CM codes from the list
of diagnosis codes used to identify cases
involving the use of the INTERCEPT
Fibrinogen Complex that would be
eligible for new technology add-on
payments.
On page 45157, we inadvertently
omitted the ICD–10–CM diagnosis codes
used to identify cases involving the use
of FETROJA® for HABP/VABP.
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58019
On page 45158, we inadvertently
omitted the ICD–10–CM diagnosis codes
used to identify cases involving the use
of RECARBRIOTM for HABP/VABP.
On pages 45291, 45293, and 45294, in
three tables that display previously
established, newly updated, and
estimated performance standards for
measures included in the Hospital
Value-Based Purchasing Program, we
are correcting errors in the numerical
values for all measures in the Clinical
Outcomes Domain that appear in the
three tables.
On page 45312, in our discussion of
payments for indirect and direct
graduate medical education costs and
Intern and Resident Information System
(IRIS) data, we made a typographical
error in our response to a comment.
On page 45386, we made an
inadvertent typographical error in our
discussion of the Hospital Inpatient
Quality Reporting (IQR) Program Severe
Hyperglycemia electronic clinical
quality measure (eCQM).
On page 45400, in our discussion of
the Hospital Inpatient Quality Reporting
(IQR) Program measures for fiscal year
(FY) 2024, we mislabeled the table title
and inadvertently included a measure
not pertaining to the FY 2024 payment
determination along with its
corresponding footnote.
On page 45404, in our discussion the
Hospital Inpatient Quality Reporting
(IQR) Program, we included a table with
the measures for the FY 2025 payment
determination. In the notes that
immediately followed the table, we
made a typographical error in the date
associated with the voluntary reporting
period for the Hybrid Hospital-Wide
All-Cause Risk Standardized Mortality
(HWM) measure.
B. Summary of Errors in the Regulations
Text
On page 45521, in the regulations text
for § 413.24(f)(5)(i) introductory text and
(f)(5)(i)(A) regarding cost reporting
forms and teaching hospitals, we
inadvertently omitted revisions that
were discussed in the preamble.
C. Summary of Errors in the Addendum
In the FY 2022 Hospital Inpatient
Prospective Payment Systems and LongTerm Care Hospital Prospective
Payment System (IPPS/LTCH PPS) final
rule (85 FR 45166), we stated that we
excluded the wage data for critical
access hospitals (CAHs) as discussed in
the FY 2004 IPPS final rule (68 FR
45397 through 45398); that is, any
hospital that is designated as a CAH by
7 days prior to the publication of the
preliminary wage index public use file
(PUF) is excluded from the calculation
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of the wage index. We inadvertently
excluded a hospital that converted to
CAH status after January 24, 2021, the
cut-off date for CAH exclusion from the
FY 2022 wage index. (CMS Certification
Number (CCN) 230118) Therefore, we
restored the wage data for this hospital
and included it in our calculation of the
wage index. This correction necessitated
the recalculation of the FY 2022 wage
index for rural Michigan (rural state
code 23), as reflected in Table 3, and
affected the final FY 2022 wage index
for rural Michigan 23 as well as the
rural floor for the State of Michigan. As
discussed in this section, the final FY
2022 IPPS wage index is used when
determining total payments for purposes
of all budget neutrality factors (except
for the MS–DRG reclassification and
recalibration budget neutrality factor)
and the final outlier threshold.
We note, in the final rule, we
correctly listed the number of hospitals
with CAH status removed from the FY
2022 wage index (86 FR 45166), the
number of hospitals used for the FY
2022 wage index (86 FR 45166) and the
number of hospital occupational mix
surveys used for the FY 2022 wage
index (86 FR 45173). Additionally, the
FY 2022 national average hourly wage
(unadjusted for occupational mix) (86
FR 45172), the FY 2022 occupational
mix adjusted national average hourly
wage (86 FR 45173), and the FY 2022
national average hourly wages for the
occupational mix nursing subcategories
(86 FR 45174) listed in the final rule
remain unchanged. Because the
numbers and values noted previously
are correctly stated in the preamble of
the final rule and remain unchanged, we
do not include any corrections in
section IV.A. of this final rule correction
and correcting amendment.
We made an inadvertent error in the
Medicare Geographic Classification
Review Board (MGCRB) reclassification
status of one hospital in the FY 2022
IPPS/LTCH PPS final rule. Specifically,
CCN 360259 is incorrectly listed in
Table 2 as reclassified to CBSA 19124.
The correct reclassification area is to its
geographic ‘‘home’’ of CBSA 45780.
This correction necessitated the
recalculation of the FY 2022 wage index
for CBSA 19124 and affected the final
FY 2022 wage index with
reclassification. The final FY 2022 IPPS
wage index with reclassification is used
when determining total payments for
purposes of all budget neutrality factors
(except for the MS–DRG reclassification
and recalibration budget neutrality
factor and the wage index budget
neutrality adjustment factor) and the
final outlier threshold.
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As discussed further in section II.E. of
this final rule correction and correcting
amendment, we made updates to the
calculation of Factor 3 of the
uncompensated care payment
methodology to reflect updated
information on hospital mergers
received in response to the final rule
and made corrections for report upload
errors. Factor 3 determines the total
amount of the uncompensated care
payment a hospital is eligible to receive
for a fiscal year. This hospital-specific
payment amount is then used to
calculate the amount of the interim
uncompensated care payments a
hospital receives per discharge. Per
discharge uncompensated care
payments are included when
determining total payments for purposes
of all of the budget neutrality factors
and the final outlier threshold. As a
result, the revisions made to the
calculation of Factor 3 to address
additional merger information and
report upload errors directly affected the
calculation of total payments and
required the recalculation of all the
budget neutrality factors and the final
outlier threshold.
Due to the correction of the
combination of errors that are discussed
previously (correcting the number of
hospitals with CAH status, the
correction to the MGCRB
reclassification status of one hospital,
and the revisions to Factor 3 of the
uncompensated care payment
methodology), we recalculated all IPPS
budget neutrality adjustment factors, the
fixed-loss cost threshold, the final wage
indexes (and geographic adjustment
factors (GAFs)), the national operating
standardized amounts and capital
Federal rate. We note that the fixed-loss
cost threshold was unchanged after
these recalculations. Therefore, we
made conforming changes to the
following:
• On page 45532, the table titled
‘‘Summary of FY 2022 Budget
Neutrality Factors’’.
• On page 45537, the estimated total
Federal capital payments and the
estimated capital outlier payments.
• On pages 45542 and 45543, the
calculation of the outlier fixed-loss cost
threshold, total operating Federal
payments, total operating outlier
payments, the outlier adjustment to the
capital Federal rate and the related
discussion of the percentage estimates
of operating and capital outlier
payments.
• On page 45545, the table titled
‘‘Changes from FY 2021 Standardized
Amounts to the FY 2022 Standardized
Amounts’’.
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On pages 45553 through 45554, in our
discussion of the determination of the
Federal hospital inpatient capital
related prospective payment rate
update, due to the recalculation of the
GAFs, we have made conforming
corrections to the capital Federal rate.
As a result of these changes, we also
made conforming corrections in the
table showing the comparison of factors
and adjustments for the FY 2021 capital
Federal rate and FY 2022 capital Federal
rate. As we noted in the final rule, the
capital Federal rate is calculated using
unrounded budget neutrality and outlier
adjustment factors. The unrounded
GAF/DRG budget neutrality factor, the
unrounded Quartile/Cap budget
neutrality factor, and the unrounded
outlier adjustment to the capital Federal
rate were revised because of these
errors. However, after rounding these
factors to 4 decimal places as displayed
in the final rule, the rounded factors
were unchanged from the final rule.
On pages 45570 and 45571, we are
making conforming corrections to the
national adjusted operating
standardized amounts and capital
standard Federal payment rate (which
also include the rates payable to
hospitals located in Puerto Rico) in
Tables 1A, 1B, 1C, and 1D as a result of
the conforming corrections to certain
budget neutrality factors, as previously
described.
D. Summary of Errors in the Appendices
On pages 45576 through 45580, 45582
through 45583, and 45598 through
45600, in our regulatory impact
analyses, we have made conforming
corrections to the factors, values, and
tables and accompanying discussion of
the changes in operating and capital
IPPS payments for FY 2022 and the
effects of certain IPPS budget neutrality
factors as a result of the technical errors
that lead to changes in our calculation
of the operating and capital IPPS budget
neutrality factors, outlier threshold,
final wage indexes, operating
standardized amounts, and capital
Federal rate (as described in section II.C.
of this final rule correction and
correcting amendment). These
conforming corrections include changes
to the following:
• On pages 45576 through 45578, the
table titled ‘‘Table I—Impact Analysis of
Changes to the IPPS for Operating Costs
for FY 2022’’.
• On pages 45582 and 45583, the
table titled ‘‘Table II—Impact Analysis
of Changes for FY 2022 Acute Care
Hospital Operating Prospective Payment
System (Payments per discharge)’’.
• On pages 45599 and 45600, the
table titled ‘‘Table III—Comparison of
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Total Payments per Case [FY 2021
Payments Compared to FY 2022
Payments]’’.
On pages 45584 and 45585 we are
correcting the maximum newtechnology add-on payment for a case
involving the use of Fetroja, Recarbrio,
Tecartus, and Abecma and related
information in the untitled tables as
well as making conforming corrections
to the total estimated FY 2022 payments
in the accompanying discussion of
applications approved or conditionally
approved for new technology add-on
payments.
On pages 45587 through 45589, we
are correcting the discussion of the
‘‘Effects of the Changes to Medicare
DSH and Uncompensated Care
Payments for FY 2022’’ for purposes of
the Regulatory Impact Analysis in
Appendix A of the FY 2022 IPPS/LTCH
PPS final rule, including the table titled
‘‘Modeled Uncompensated Care
Payments for Estimated FY 2022 DSHs
by Hospital Type: Uncompensated Care
Payments ($ in Millions)*—from FY
2021 to FY 2022’’, in light of the
corrections discussed in section II.E. of
this final rule correction and correcting
amendment.
On pages 45610 and 45611, we are
making conforming corrections to the
estimated expenditures under the IPPS
as a result of the corrections to the
maximum new technology add-on
payment for a case involving the use of
AprevoTM Intervertebral Body Fusion
Device, Fetroja, Recarbrio, Abecma, and
Tecartus as described in this section and
in section II.A. of this final rule
correction and correcting amendment.
E. Summary of Errors in and Corrections
to Files and Tables Posted on the CMS
Website
We are correcting the errors in the
following IPPS tables that are listed on
pages 45569 and 45570 of the FY 2022
IPPS/LTCH PPS final rule and are
available on the internet on the CMS
website at https://www.cms.gov/
Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/
index.html. The tables that are available
on the internet have been updated to
reflect the revisions discussed in this
final rule correction and correcting
amendment.
Table 2—Case-Mix Index and Wage
Index Table by CCN–FY 2022 Final
Rule. As discussed in section II.C. of
this final rule correction and correcting
amendment, we inadvertently excluded
a hospital that converted to CAH status
after January 24, 2021, the cut-off date
for CAH exclusion from the FY 2022
wage index. (CMS Certification Number
(CCN) 230118). Therefore, we restored
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provider 230118 to the table. Also, as
discussed in section II.C. of this final
rule correction and correcting
amendment, CCN 360259 is incorrectly
listed as reclassified to CBSA 19124.
The correct reclassification area is to its
geographic ‘‘home’’ of CBSA 45780. In
this table, we are correcting the columns
titled ‘‘Wage Index Payment CBSA’’ and
‘‘MGCRB Reclass’’ to accurately reflect
its reclassification to CBSA 45780. This
correction necessitated the recalculation
of the FY 2022 wage index for CBSA
19124. As also discussed later in this
section, because the wage indexes are
one of the inputs used to determine the
out-migration adjustment, some of the
out-migration adjustments changed.
Therefore, we are making corresponding
changes to the affected values.
Table 3.—Wage Index Table by
CBSA—FY 2022 Final Rule. As
discussed in section II.C. of this final
rule correction and correcting
amendment, we inadvertently excluded
a hospital that converted to CAH status
after January 24, 2021, the cut-off date
for CAH exclusion from the FY 2022
wage index. (CMS Certification Number
(CCN) 230118). Therefore, we
recalculated the wage index for rural
Michigan (rural state code 23), as
reflected in Table 3, as well as the rural
floor for the State of Michigan. Also, as
discussed in section II.C. of this final
rule correction and correcting
amendment, CCN 360259 is incorrectly
listed as reclassified to CBSA 19124.
The correct reclassification area is to its
geographic ‘‘home’’ of CBSA 45780. In
this table, we are correcting the values
that changed as a result of these
corrections as well as any corresponding
changes.
Table 4A.—List of Counties Eligible
for the Out-Migration Adjustment under
Section 1886(d)(13) of the Act—FY 2022
Final Rule. As discussed in section II.C.
of this final rule correction and
correcting amendment, we inadvertently
excluded a hospital that converted to
CAH status after January 24, 2021, the
cut-off date for CAH exclusion from the
FY 2022 wage index. (CMS Certification
Number (CCN) 230118). Also, as
discussed in section II.C. of this final
rule correction and correcting
amendment, CCN 360259 is incorrectly
listed as reclassified to CBSA 19124.
The correct reclassification area is to its
geographic ‘‘home’’ of CBSA 45780. As
a result, as discussed previously, we are
making changes to the FY 2022 wage
indexes. Because the wage indexes are
one of the inputs used to determine the
out-migration adjustment, some of the
out-migration adjustments changed.
Therefore, we are making corresponding
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58021
changes to some of the out-migration
adjustments listed in Table 4A.
Table 6B.—New Procedure Codes—
FY 2022. We are correcting this table to
reflect the assignment of procedure
codes XW033A7 (Introduction of
ciltacabtagene autoleucel into
peripheral vein, percutaneous approach,
new technology group 7) and XW043A7
(Introduction of ciltacabtagene
autoleucel into central vein,
percutaneous approach, new technology
group 7) to Pre-MDC MS–DRG 018
(Chimeric Antigen Receptor (CAR) Tcell and Other Immunotherapies). Table
6B inadvertently omitted Pre-MDC MS–
DRG 018 in Column E (MS–DRG) for
assignment of these codes. Effective
with discharges on and after April 1,
2022, conforming changes will be
reflected in the Version 39.1 ICD–10
MS–DRG Definitions Manual and ICD–
10 MS–DRG Grouper and Medicare
Code Editor software.
Table 6P.—ICD–10–CM and ICD–10–
PCS Codes for MS–DRG Changes—FY
2022. We are correcting Table 6P.1d
associated with the final rule to reflect
three procedure codes submitted by the
requestor that were inadvertently
omitted, resulting in 79 procedure codes
listed instead of 82 procedure codes as
indicated in the final rule (see pages
44808 and 44809).
Table 18.—Final FY 2022 Medicare
DSH Uncompensated Care Payment
Factor 3. For the FY 2022 IPPS/LTCH
PPS final rule, we published a list of
hospitals that we identified to be
subsection (d) hospitals and subsection
(d) Puerto Rico hospitals projected to be
eligible to receive interim
uncompensated care payments for FY
2022. As stated in the FY 2022 IPPS/
LTCH PPS final rule (86 FR 45249), we
allowed the public an additional period
after the issuance of the final rule to
review and submit comments on the
accuracy of the list of mergers that we
identified in the final rule. Based on the
comments received during this
additional period, we are updating this
table to reflect the merger information
received in response to the final rule
and to revise the Factor 3 calculations
for purposes of determining
uncompensated care payments for the
FY 2022 IPPS/LTCH PPS final rule. We
are revising Factor 3 for all hospitals to
reflect the updated merger information
received in response to the final rule.
We are also revising the amount of the
total uncompensated care payment
calculated for each DSH eligible
hospital. The total uncompensated care
payment that a hospital receives is used
to calculate the amount of the interim
uncompensated care payments the
hospital receives per discharge;
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accordingly, we have also revised these
amounts for all DSH eligible hospitals.
These corrections will be reflected in
Table 18 and the Medicare DSH
Supplemental Data File. Per discharge
uncompensated care payments are
included when determining total
payments for purposes of all of the
budget neutrality factors and the final
outlier threshold. As a result, these
corrections to uncompensated care
payments required the recalculation of
all the budget neutrality factors as well
as the outlier fixed-loss cost threshold.
We note that the fixed-loss cost
threshold was unchanged after these
recalculations. In section IV.C. of this
final rule correction and correcting
amendment, we have made
corresponding revisions to the
discussion of the ‘‘Effects of the Changes
to Medicare DSH and Uncompensated
Care Payments for FY 2022’’ for
purposes of the Regulatory Impact
Analysis in Appendix A of the FY 2022
IPPS/LTCH PPS final rule to reflect the
corrections discussed previously and to
correct minor typographical errors. The
files that are available on the internet
have been updated to reflect the
ICD-10-PCS
code
02703Z6
02703ZZ
02704Z6
02704ZZ
02C03Z6
02C03ZZ
02C04Z6
02C04ZZ
02713Z6
02713ZZ
02714Z6
02714ZZ
02C13Z6
02C13ZZ
02C14Z6
02C14ZZ
02723Z6
02723ZZ
02724Z6
02724ZZ
02C23Z6
02C23ZZ
02C24Z6
02C24ZZ
02733Z6
02733ZZ
02734Z6
02734ZZ
02C33Z6
02C33ZZ
02C34Z6
02C34ZZ
Description
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Dilation of coronary artery, one artery, bifurcation, percutaneous approach.
Dilation of coronary artery, one artery, percutaneous approach.
Dilation of coronary artery, one artery, bifurcation, percutaneous endoscopic approach.
Dilation of coronary artery, one artery, percutaneous endoscopic approach.
Extirpation of matter from coronary artery, one artery, bifurcation, percutaneous approach.
Extirpation of matter from coronary artery, one artery, percutaneous approach.
Extirpation of matter from coronary artery, one artery, bifurcation, percutaneous endoscopic approach.
Extirpation of matter from coronary artery, one artery, percutaneous endoscopic approach.
Dilation of coronary artery, two arteries, bifurcation, percutaneous approach.
Dilation of coronary artery, two arteries, percutaneous approach.
Dilation of coronary artery, two arteries, bifurcation, percutaneous endoscopic approach.
Dilation of coronary artery, two arteries, percutaneous endoscopic approach.
Extirpation of matter from coronary artery, two arteries, bifurcation, percutaneous approach.
Extirpation of matter from coronary artery, two arteries, percutaneous approach.
Extirpation of matter from coronary artery, two arteries, bifurcation, percutaneous endoscopic approach.
Extirpation of matter from coronary artery, two arteries, percutaneous endoscopic approach.
Dilation of coronary artery, three arteries, bifurcation, percutaneous approach.
Dilation of coronary artery, three arteries, percutaneous approach.
Dilation of coronary artery, three arteries, bifurcation, percutaneous endoscopic approach.
Dilation of coronary artery, three arteries, percutaneous endoscopic approach.
Extirpation of matter from coronary artery, three arteries, bifurcation, percutaneous approach.
Extirpation of matter from coronary artery, three arteries, percutaneous approach.
Extirpation of matter from coronary artery, three arteries, bifurcation, percutaneous endoscopic approach.
Extirpation of matter from coronary artery, three arteries, percutaneous endoscopic approach.
Dilation of coronary artery, four or more arteries, bifurcation, percutaneous approach.
Dilation of coronary artery, four or more arteries, percutaneous approach.
Dilation of coronary artery, four or more arteries, bifurcation, percutaneous endoscopic approach.
Dilation of coronary artery, four or more arteries, percutaneous endoscopic approach.
Extirpation of matter from coronary artery, four or more arteries, bifurcation, percutaneous approach.
Extirpation of matter from coronary artery, four or more arteries, percutaneous approach.
Extirpation of matter from coronary artery, four or more arteries, bifurcation, percutaneous endoscopic approach.
Extirpation of matter from coronary artery, four or more arteries, percutaneous endoscopic approach.
We have corrected the ICD–10 MS–
DRG Definitions Manual Version 39 and
the ICD–10 MS–DRG GROUPER and
MCE Version 39 Software to correctly
reflect the inclusion of these codes in
the arterial logic lists for MS–DRGs 246
and 248 for FY 2022.
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III. Waiver of Proposed Rulemaking
and Delay in Effective Date
Under 5 U.S.C. 553(b) of the
Administrative Procedure Act (APA),
the agency is required to publish a
notice of the proposed rulemaking in
the Federal Register before the
provisions of a rule take effect.
Similarly, section 1871(b)(1) of the Act
requires the Secretary to provide for
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corrections discussed in this final rule
correction and correcting amendment.
In addition, we are correcting the
inadvertent omission of the following 32
ICD–10–PCS codes describing
percutaneous cardiovascular procedures
involving one, two, three or four arteries
from the GROUPER logic for MS–DRG
246 (Percutaneous Cardiovascular
Procedures with Drug-Eluting Stent
with MCC or 4+ Arteries or Stents) and
MS–DRG 248 (Percutaneous
Cardiovascular Procedures with NonDrug-Eluting Stent with MCC or 4+
Arteries or Stents).
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notice of the proposed rulemaking in
the Federal Register and provide a
period of not less than 60 days for
public comment. In addition, section
553(d) of the APA, and section
1871(e)(1)(B)(i) of the Act mandate a 30day delay in effective date after issuance
or publication of a rule. Sections
553(b)(B) and 553(d)(3) of the APA
provide for exceptions from the notice
and comment and delay in effective date
APA requirements; in cases in which
these exceptions apply, sections
1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the
Act provide exceptions from the notice
and 60-day comment period and delay
in effective date requirements of the Act
as well. Section 553(b)(B) of the APA
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and section 1871(b)(2)(C) of the Act
authorize an agency to dispense with
normal rulemaking requirements for
good cause if the agency makes a
finding that the notice and comment
process are impracticable, unnecessary,
or contrary to the public interest. In
addition, both section 553(d)(3) of the
APA and section 1871(e)(1)(B)(ii) of the
Act allow the agency to avoid the 30day delay in effective date where such
delay is contrary to the public interest
and an agency includes a statement of
support.
We believe that this final rule
correction and correcting amendment
does not constitute a rule that would be
subject to the notice and comment or
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delayed effective date requirements.
This document corrects technical and
typographical errors in the preamble,
regulations text, addendum, payment
rates, tables, and appendices included
or referenced in the FY 2022 IPPS/LTCH
PPS final rule, but does not make
substantive changes to the policies or
payment methodologies that were
adopted in the final rule. As a result,
this final rule correction and correcting
amendment is intended to ensure that
the information in the FY 2022 IPPS/
LTCH 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 providers to receive
appropriate payments in as timely a
MDC
MS–DRG
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*
08 ...................................
08 ...................................
*
521
522
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would be contrary to the public interest
not to implement the corrections in this
final rule correction and correcting
amendment because it is in the public’s
interest for providers to receive
appropriate payments in as timely a
manner as possible, and to ensure that
the FY 2022 IPPS/LTCH PPS final rule
accurately reflects our policies.
IV. Correction of Errors
In FR Doc. 2021–16519 of August 13,
2021 (86 FR 44774), we are making the
following corrections:
A. Correction of Errors in the Preamble
1. On page 44878, second column, last
paragraph, line 10, ‘‘15 technologies’’ is
corrected to read ‘‘technologies.’’
2. On page 44889, lower two-thirds of
the page, third column, partial
paragraph, line 10, the procedure code
‘‘0DQ540ZZ’’ is corrected to read
‘‘0DQ54ZZ.’’
3. On page 44960, in the untitled
table, last 2 lines are corrected to read
as follows:
MS–DRG title
*
*
*
*
Hip Replacement with Principal Diagnosis of Hip Fracture with MCC.
Hip Replacement with Principal Diagnosis of Hip Fracture without MCC.
4. On page 45047:
a. Second column, first full paragraph,
lines 21 through 24, the sentence ‘‘We
summarize comments related to this
comment solicitation and provide our
responses as well as our finalized policy
in section XXX of this final rule.’’ is
corrected to read ‘‘We summarize
comments related to this comment
solicitation and provide our responses
in section II.F.7. of the preamble of this
final rule.’’.
b. Third column, first full paragraph,
line 28, the reference ‘‘section XXX’’ is
corrected to read ‘‘section II.F.8.’’.
5. On page 45048, second column,
second full paragraph, lines 20 through
24, the sentence ‘‘We summarize
comments related to this comment
solicitation and provide our responses
as well as our finalized policy in section
XXX of this final rule.’’ is corrected to
read ‘‘We summarize comments related
to this comment solicitation and
provide our responses in section II.F.7.
of the preamble of this final rule.’’.
6. On page 45049:
a. Second column:
(1) First full paragraph, line 12, the
reference, ‘‘section XXX of this final
rule’’ is corrected to read ‘‘section II.F.8.
of the preamble of this final rule’’.
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manner as possible, and to ensure that
the FY 2022 IPPS/LTCH PPS final rule
accurately reflects our policies.
Furthermore, such procedures would be
unnecessary, as we are not altering our
payment methodologies or policies, but
rather, we are simply implementing
correctly the methodologies and policies
that we previously proposed, requested
comment on, and subsequently
finalized. This final rule correction and
correcting amendment is intended
solely to ensure that the FY 2022 IPPS/
LTCH PPS final rule accurately reflects
these payment methodologies and
policies. Therefore, 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
(2) Second full paragraph, lines 1 and
2, the reference, ‘‘section XXX of this
final rule’’ is corrected to read ‘‘section
II.F.7. J95.851 (Ventilator associated
pneumonia) and one of the following:
B96.1 (Klebsiella pneumoniae [K.
pneumoniae] as the cause of diseases
classified elsewhere), B96.20
(Unspecified Escherichia coli [E. coli] as
the cause of diseases classified
elsewhere), B96.21 (Shiga toxinproducing Escherichia coli [E. coli]
[STEC] O157 as the cause of diseases
classified elsewhere), B96.22 (Other
specified Shiga toxin-producing
Escherichia coli [E. coli] [STEC] as the
cause of diseases classified elsewhere),
B96.23 (Unspecified Shiga toxinproducing Escherichia coli [E. coli]
[STEC] as the cause of diseases
classified elsewhere, B96.29 (Other
Escherichia coli [E. coli] as the cause of
diseases classified elsewhere), B96.3
(Hemophilus influenzae [H. influenzae]
as the cause of diseases classified
elsewhere, B96.5 (Pseudomonas
(aeruginosa) (mallei) (pseudomallei) as
the cause of diseases classified
elsewhere), or B96.89 (Other specified
bacterial agents as the cause of diseases
classified elsewhere) for VABP.’’
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*
10. On page 45158, third column, first
partial paragraph, last line the phrase,
‘‘technology group 5).’’ is corrected to
read ‘‘technology group 5) in
combination with the following ICD–
10–CM codes: Y95 (Nosocomial
condition) and one of the following:
J14.0 (Pneumonia due to Hemophilus
influenzae) J15.0 (Pneumonia due to
Klebsiella pneumoniae), J15.1
(Pneumonia due to Pseudomonas), J15.5
(Pneumonia due to Escherichia coli),
J15.6 (Pneumonia due to other Gramnegative bacteria), or J15.8 (Pneumonia
due to other specified bacteria) for
HABP and ICD10–PCS codes: XW033A6
(Introduction of cefiderocol antinfective
into peripheral vein, percutaneous
approach, new technology group 6) or
XW043A6 (Introduction of cefiderocol
anti-infective into central vein,
percutaneous approach, new technology
group 6) in combination with the
following ICD–10–CM codes: J95.851
(Ventilator associated pneumonia) and
one of the following: B96.1 (Klebsiella
pneumoniae [K. pneumoniae] as the
cause of diseases classified elsewhere),
B96.20 (Unspecified Escherichia coli [E.
coli] as the cause of diseases classified
elsewhere), B96.21 (Shiga toxinproducing Escherichia coli [E. coli]
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Escherichia coli [E. coli] as the cause of
diseases classified elsewhere), B96.3
(Hemophilus influenzae [H. influenzae]
as the cause of diseases classified
elsewhere, B96.5 (Pseudomonas
(aeruginosa) (mallei)(pseudomallei) as
the cause of diseases classified
elsewhere), or B96.89 (Other specified
[STEC] O157 as the cause of diseases
classified elsewhere), B96.22 (Other
specified Shiga toxin-producing
Escherichia coli [E. coli] [STEC] as the
cause of diseases classified elsewhere),
B96.23 (Unspecified Shiga toxinproducing Escherichia coli [E. coli]
[STEC] as the cause of diseases
classified elsewhere, B96.29 (Other
bacterial agents as the cause of diseases
classified elsewhere) for VABP.’’
11. On page 45291, middle of the
page, the table titled ‘‘Table V.H–11:
Previously Established and Newly
Updated Performance Standards for the
FY 2024 Program Year’’ is corrected to
read as follows:
TABLE V.H–11—PREVIOUSLY ESTABLISHED AND ESTIMATED PERFORMANCE STANDARDS FOR THE FY 2024 PROGRAM
YEAR
Achievement
threshold
Measure short name
Benchmark
Clinical Outcomes Domain
MORT–30–AMI #
......................................................................................................................................................
MORT–30–HF # ........................................................................................................................................................
MORT–30–PN (updated cohort) # ............................................................................................................................
MORT–30–COPD # ..................................................................................................................................................
MORT–30–CABG # ..................................................................................................................................................
COMP–HIP–KNEE * # ..............................................................................................................................................
0.869247
0.882308
0.840281
0.916491
0.969499
0.025396
0.887868
0.907773
0.872976
0.934002
0.980319
0.018159
♦ As discussed in section V.H.4.b. of this final rule, we are finalizing the updates to the FY 2024 baseline periods for measures included in the
Person and Community Engagement, Safety, and Efficiency and Cost Reduction domains to use CY 2019. Therefore, the performance standards
displayed in this table for the Safety domain measures were calculated using CY 2019 data.
* Lower values represent better performance.
# Previously established performance standards.
12. On page 45293, top of the page,
the table titled ‘‘V.H–13 Previously
Established and Estimated Performance
Standards for the FY 2025 Program
Year’’ is corrected to read as follows:
TABLE V.H–13—PREVIOUSLY ESTABLISHED AND ESTIMATED PERFORMANCE STANDARDS FOR THE FY 2025 PROGRAM
YEAR
Achievement
threshold
Measure short name
Benchmark
Clinical Outcomes Domain
MORT–30–AMI # ......................................................................................................................................................
MORT–30–HF # ........................................................................................................................................................
MORT–30–PN (updated cohort) # ............................................................................................................................
MORT–30–COPD # ..................................................................................................................................................
MORT–30–CABG # ..................................................................................................................................................
COMP–HIP–KNEE * # ..............................................................................................................................................
0.872624
0.883990
0.841475
0.915127
0.970100
0.025332
0.889994
0.910344
0.874425
0.932236
0.979775
0.017946
* Lower values represent better performance.
# Previously established performance standards.
13. On page 45294, top of page, the
table titled ‘‘V.H–14 Previously
Established and Estimated Performance
Standards for the FY 2026 Program
Year’’ is corrected to read as follows:
TABLE V.H–14—PREVIOUSLY ESTABLISHED AND ESTIMATED PERFORMANCE STANDARDS FOR THE FY 2026 PROGRAM
YEAR
Achievement
threshold
Measure short name
Benchmark
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Clinical Outcomes Domain
MORT–30–AMI # ......................................................................................................................................................
MORT–30–HF # ........................................................................................................................................................
MORT–30–PN (updated cohort) # ............................................................................................................................
MORT–30–COPD # ..................................................................................................................................................
MORT–30–CABG # ..................................................................................................................................................
COMP–HIP–KNEE * # ..............................................................................................................................................
* Lower values represent better performance.
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0.874426
0.885949
0.843369
0.914691
0.970568
0.024019
0.890687
0.912874
0.877097
0.932157
0.980473
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Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
# Previously
58025
established performance standards.
14. On page 45312, second column,
first full paragraph, lines 7 through 9,
the phrase ‘‘rejection of the cost report
if the submitted IRIS GME and IME
FTEs do match’’ is corrected to read
‘‘rejection of the cost report if the
submitted IRIS GME and IME FTEs do
not match’’.
15. On page 45386, third column, first
full paragraph, line 12, the phrase
‘‘mellitus and who either’’ is corrected
to read ‘‘mellitus, who’’.
16. On page 45400, top of the page,
the table titled ‘‘Measures for the FY
2024 Payment Determination and
Subsequent Years’’, is corrected by—
a. Correcting the title to read
‘‘Measures for the FY 2023 Payment
Determination and Subsequent Years’’.
b. Removing the heading ‘‘Claims and
Electronic Data Measures’’ and the entry
‘‘Hybrid HWR**’’ (rows 20 and 21).
c. Following the table, lines 3 through
8, removing the second table note.
17. On page 45404, bottom of the
page, after the table titled ‘‘Measures for
the FY 2025 Payment Determination
and Subsequent Years’’, in the third
note to the table, line 10, the
parenthetical phrase ‘‘(July 1, 2023–June
30, 2023)’’ is corrected to read ‘‘(July 1,
2022–June 30, 2023)’’.
B. Correction of Errors in the Addendum
1. On page 45532, bottom of the page,
the table titled ‘‘Summary of FY 2022
Budget Neutrality Factors’’ is corrected
to read as follows:
SUMMARY OF FY 2022 BUDGET NEUTRALITY FACTORS
MS-DRG Reclassification and Recalibration Budget Neutrality Factor ..............................................................................................
Wage Index Budget Neutrality Factor .................................................................................................................................................
Reclassification Budget Neutrality Factor ............................................................................................................................................
*Rural Floor Budget Neutrality Factor .................................................................................................................................................
Rural Demonstration Budget Neutrality Factor ...................................................................................................................................
Low Wage Index Hospital Policy Budget Neutrality Factor ................................................................................................................
Transition Budget Neutrality Factor .....................................................................................................................................................
1.000107
1.000715
0.986741
0.992868
0.999361
0.998029
0.999859
* The rural floor budget neutrality factor is applied to the national wage indexes while the rest of the budget neutrality adjustments are applied
to the standardized amounts.
2. On page 45537, first column, first
full paragraph, lines 4 through 10, the
parenthetical phrase ‘‘(estimated capital
outlier payments of $ 430,689,396
divided by (estimated capital outlier
payments of $430,689,396 plus the
estimated total capital Federal payment
of $7,676,990,253)).’’ is corrected to read
‘‘(estimated capital outlier payments of
$430,698,533 divided by (estimated
capital outlier payments of
$430,698,533 plus the estimated total
capital Federal payment of
$7,676,964,386)).’’.
3. On page 45542, third column, last
paragraph, lines 23 and 24, the figure
‘‘$5,326,356,951’’ is corrected to read
‘‘$5,326,379,560’’.
4. On page 45543:
a. Top of the page, first column, first
partial paragraph:
(1) Line 1, the figure
‘‘$100,164,666,975’’ is corrected to read
‘‘$100,165,281,272’’.
(2) Line 17, the figure ‘‘$31,108’’ is
corrected to read ‘‘$31,109’’.
b. Middle of the page, the untitled
table is corrected to read as follows:
Operating
standardized
amounts
National ....................................................................................................................................................................
0.949
Capital
Federal
rate *
0.947078
* The adjustment factor for the capital Federal rate includes an adjustment to the estimated percentage of FY 2022 capital outlier payments for
capital outlier reconciliation, as discussed previously and in section III. A. 2 in the Addendum of this final rule.
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5. On page 45545, the table titled
‘‘CHANGES FROM FY 2021
STANDARDIZED AMOUNTS TO THE
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FY 2022 STANDARDIZED AMOUNTS’’
is corrected to read as follows:
BILLING CODE 4120–01–P
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CHANGES FROM FY 2021 STANDARDIZED AMOUNTS TO THE FY 2022
STANDARDIZED AMOUNTS
FY 2022 Base Rate after removing:
1. FY 2021 Geographic Reclassification
Budget Neutrality (0.986616)
2. FY 2021 Operating Outlier Offset (0.949)
3. FY 2021 Rural Demonstration Budget
Neutrality Factor (0.999626)
4. FY 2021 Lowest Quartile Budget Neutrality
Factor (0.99797)
5. FY 2021 Transition Budget Neutrality
Factor (0.998851)
FY 2022 Uodate Factor
FY 2022 MS-DRG Reclassification and
Recalibration Budaet Neutrality Factor
FY 2022 Wage Index Budget Neutrality Factor
FY 2022 Reclassification Budget Neutrality
Factor
FY 2022 Rural Demonstration Budget
Neutralitv Factor
FY 2022 Lowest Quartile Budget Neutrality
Factor
FY 2022 Transition Budqet Neutrality Factor
FY 2022 Ooeratina Outlier Factor
Adjustment for FY 2022 Required under
Section 414 of Pub. L.114-10 (MACRA)
National Standardized Amount for FY 2022
if Wage Index is Greater Than 1.0000;
Labor/Non-Labor Share Percentage
167 .6/32.41
National Standardized Amount for FY 2022
if Wage Index is Less Than or Equal to
1.0000; Labor/Non-Labor Share Percentage
162/381
Hospital Submitted Quality
Data and is a Meaningful
EHR User
If Wage Index is Greater
Than 1.0000:
Labor (67.6%): $4,319.35
Nonlabor (32.4%): $ 2,070.22
If Wage Index is less Than or
Equal to 1.0000:
Labor (62%): $3,961.53
Nonlabor (38%): $ 2,428.04
Hospital Submitted Quality
Data and is NOT a
Meaninaful EHR User
If Wage Index is Greater Than
1.0000:
Labor(67.6%): $4,319.35
Nonlabor (32.4%): $2,070.22
If Wage Index is less Than or
Equal to 1.0000:
Labor (62%): $ 3,961.53
Nonlabor (38%): $ 2,428.04
Hospital Did NOT Submit
Quality Data and is a
Meaninaful EHR User
If Wage Index is Greater Than
1.0000:
Labor(67.6%): $4,319.35
Nonlabor (32.4%): $2,070.22
If Wage Index is less Than or
Equal to 1.0000:
Labor (62%): $ 3,961.53
Nonlabor (38%): $ 2,428.04
Hospital Did NOT Submit
Quality Data and is NOT a
Meaninaful EHR User
If Wage Index is Greater Than
1.0000:
Labor (67.6%): $4,319.35
Nonlabor (32.4%): $2,070.22
If Wage Index is less Than or
Equal to 1.0000:
Labor (62%): $ 3,961.53
Nonlabor (38%): $ 2,428.04
1.02
0.99975
1.01325
0.993
1.000107
1.000715
1.000107
1.000715
1.000107
1.000715
1.000107
1.000715
0.986741
0.986741
0.986741
0.986741
0.999361
0.999361
0.999361
0.999361
0.998029
0.999859
0.949
0.998029
0.999859
0.949
0.998029
0.999859
0.949
0.998029
0.999859
0.949
1.005
1.005
1.005
1.005
Labor: $4,138.24
Nonlabor $1,983.41
Labor: $4,056.08
Nonlabor: $1,944.03
Labor: $4,110.85
Nonlabor: $1,970.28
Labor: $4,028.70
Nonlabor: $1,930.91
Labor: $3,795.42
Nonlabor: $2 326.23
Labor: $3,720.07
Non labor: $2 280.04
Labor: $3,770.30
Non labor: $2 310.83
Labor: $3,694.96
Nonlabor: $2 264.65
BILLING CODE 4120–01–C
6. On page 45553, second column, last
paragraph, line 9, the figure ‘‘$472.60’’
is corrected to read ‘‘$472.59’’.
7. On page 45554, top of the page, in
the table titled ‘‘COMPARISON OF
FACTORS AND ADJUSTMENTS: FY
2021 CAPITAL FEDERAL RATE AND
THE FY 2022 CAPITAL FEDERAL
RATE’’, the list entry (row 5) is
corrected to read as follows:
COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2021 CAPITAL FEDERAL RATE AND THE FY 2022 CAPITAL FEDERAL
RATE
FY 2021
*
*
*
*
Capital Federal Rate ........................................................................................
8. On page 45570:
a. The table titled ‘‘TABLE 1A.—
NATIONAL ADJUSTED OPERATING
*
$466.21
STANDARDIZED AMOUNTS, LABOR/
NONLABOR (67.6 PERCENT LABOR
SHARE/32.4 PERCENT NONLABOR
FY 2022
Change
*
$472.59
Percent
change
*
1.0137
4 1.37
SHARE IF WAGE INDEX IS GREATER
THAN 1)—FY 2022’’ is corrected to read
as follows:
TABLE 1A—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (67.6 PERCENT LABOR
SHARE/32.4 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1)—FY 2022
Hospital submitted quality data
and is not a meaningful EHR user
(update = ¥0.025 percent)
Hospital did not submit quality
data and is a meaningful
EHR user
(update = 1.325 percent)
Hospital did not submit quality
data and is not a meaningful
EHR user
(update = ¥0.7 percent)
Labor
Nonlabor
Labor
Nonlabor
Labor
Nonlabor
Labor
Nonlabor
$4,138.24
$1,983.41
$4,056.08
$1,944.03
$4,110.85
$1,970.28
$4,028.70
$1,930.91
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and is a meaningful EHR user
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Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
b. The table titled ‘‘TABLE 1B.—
NATIONAL ADJUSTED OPERATING
STANDARDIZED AMOUNTS, LABOR/
NONLABOR (62 PERCENT LABOR
SHARE/38 PERCENT NONLABOR
SHARE IF WAGE INDEX IS LESS
58027
THAN OR EQUAL TO 1)—FY 2022’’ is
corrected to read as follows:
TABLE 1B—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/
38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2022
Hospital submitted quality data
and is a meaningful EHR user
(update = 2.0 percent)
Hospital submitted quality data
and is not a meaningful EHR user
(update = ¥0.025 percent)
Hospital did not submit quality
data and is a meaningful
EHR user
(update = 1.325 percent)
Hospital did not submit quality
data and is not a meaningful
EHR user
(update = ¥0.7 percent)
Labor
Nonlabor
Labor
Nonlabor
Labor
Nonlabor
Labor
Nonlabor
$3,795.42
$2,326.23
$3,720.07
$2,280.04
$3,770.30
$2,310.83
$3,694.96
$2,264.65
9. On page 45571, the top of page:
a. The table titled ‘‘Table 1C.—
ADJUSTED OPERATING
STANDARDIZED AMOUNTS FOR
HOSPITALS IN PUERTO RICO,
LABOR/NONLABOR (NATIONAL: 62
PERCENT LABOR SHARE/38 PERCENT
NONLABOR SHARE BECAUSE WAGE
INDEX IS LESS THAN OR EQUAL TO
1)—FY 2022’’ is corrected to read as
follows:
TABLE 1C—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL: 62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR
EQUAL TO 1)—FY 2022
Rates if wage index greater than 1
Labor
1 National
1 For
......................
Hospital is a meaningful EHR
user and wage index less than
or equal to 1
(update = 2.0)
Nonlabor
Not Applicable .............
Not Applicable .............
Hospital is NOT a meaningful
EHR user and wage index less
than or equal to 1
(update = 1.325)
Labor
Nonlabor
Labor
Nonlabor
$3,795.42
$2,326.23
$3,770.30
$2,310.83
FY 2022, there are no CBSAs in Puerto Rico with a national wage index greater than 1.
b. The table titled ‘‘TABLE 1D.—
CAPITAL STANDARD FEDERAL
PAYMENT RATE—FY 2022’’ is
corrected to read as follows:
TABLE 1D—CAPITAL STANDARD
FEDERAL PAYMENT RATE—FY 2022
Rate
National .................................
$472.59
C. Correction of Errors in the
Appendices
1. On pages 45576 through 45578, the
table titled ‘‘Table I.—Impact Analysis
of Changes to the IPPS for Operating
Costs for FY 2022’’ is corrected to read
as follows:
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E:\FR\FM\20OCR1.SGM
20OCR1
ER20OC21.001</GPH>
All Hospitals
Bv Geo!!raohic Location:
Urban hosoitals
Rural hospitals
Bed Size (Urban):
0-99 beds
100-199 beds
200-299 beds
300-499 beds
500 or more beds
Bed Size (Rural):
0-49 beds
50-99 beds
100-149 beds
150-199 beds
200 or more beds
Urban by Re!!ion:
New England
Middle Atlantic
East North Central
West North Central
South Atlantic
East South Central
West South Central
Mountain
Pacific
Puerto Rico
Rural by Re2ion:
New England
Middle Atlantic
East North Central
West North Central
South Atlantic
East South Central
West South Central
Number
of
Hospitals'
3,195
Hospital
Rate
Update and
Adjustment
under
MACRA
(1)2
2.5
FY2022
Weights and
DRG
Changes with
Application
of
Recalibration
Budget
Neutrality
(2) 3
0.0
FY 2022
Wage Data
with
Application
ofWage
Budget
Neutrality
(3) 4
0.0
0.0
0.0
0.2
0.1
2.6
2,459
736
2.5
2.2
0.0
0.1
0.0
0.2
-0.1
1.3
0.0
-0.2
0.2
0.0
0.1
0.1
2.6
2.8
634
754
427
421
223
2.4
2.5
2.5
2.5
2.5
0.0
0.0
0.0
0.0
0.0
0.1
0.0
0.1
0.0
-0.1
-0.6
-0.2
0.2
0.1
-0.3
0.1
0.2
0.0
0.0
0.0
0.2
0.2
0.2
0.1
0.2
0.3
0.2
0.1
0.1
0.0
2.7
2.6
2.4
2.6
2.6
311
253
94
39
39
2.1
2.1
2.1
2.3
2.3
0.1
0.1
0.1
0.0
0.0
0.3
0.2
0.2
0.2
0.3
0.7
0.8
1.3
1.6
2.0
-0.1
-0.1
-0.2
-0.2
-0.3
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.0
0.1
0.0
4.3
2.4
2.5
2.6
2.8
112
304
381
160
402
144
364
172
370
50
2.5
2.5
2.5
2.4
2.5
2.5
2.5
2.4
2.4
2.5
0.0
0.0
0.0
-0.1
0.0
0.0
0.0
0.0
-0.1
-0.5
-1.0
-0.2
-0.2
0.2
0.3
0.1
-0.3
0.2
0.5
-0.3
0.8
0.3
-0.2
-0.6
-0.5
-0.3
-0.5
0.1
0.2
-1.0
3.7
-0.4
-0.4
-0.3
-0.3
-0.3
-0.3
-0.1
0.4
0.2
0.6
0.5
0.0
0.0
0.2
0.0
0.0
0.0
0.0
0.0
0.1
0.2
0.0
0.6
0.0
0.0
0.0
0.2
0.1
0.1
2.7
2.5
2.4
2.7
2.9
2.5
2.3
2.6
2.5
1.7
19
50
113
89
114
144
135
2.3
2.2
2.2
2.1
2.2
2.3
2.2
0.0
0.1
0.1
0.0
0.1
0.1
0.1
-0.4
0.3
0.1
0.1
1.1
-0.1
0.0
1.3
1.0
0.9
0.3
1.6
1.8
2.8
-0.3
-0.2
-0.1
-0.1
-0.2
-0.3
-0.3
0.2
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.2
0.0
0.1
0.0
3.4
2.6
2.2
2.8
3.0
2.6
3.0
FY2022
MGCRB
Reclassifications
Rural
Floor with
Application
of National
Rural
Floor
Budget
Neutrality
(4) s
(5)6
Imputed
Floor
Wage
Index
Application
of the
Frontier
State Wage
Index and
Outmigration
Adjustment
AIIFY
2022
Changes
(6) 7
(7)"
(8)9
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
Table 1.-Impact Analysis of Changes to the IPPS for Operating Costs for FY 2022
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1.9
2.1
1,983
1,212
2.5
2.4
2,031
907
257
Number
of
Hospitals 1
48
24
Hospital
Rate
Update and
Adjustment
under
MACRA
(1)2
FY2022
Wage Data
with
Application
ofWage
Budget
Neutrality
(3) 4
FY2022
MGCRB
Reclassifications
Rural
Floor with
Application
of National
Rural
Floor
Budget
Neutrality
(4) s
(5)6
Fmt 4700
0.6
-0.1
-0.1
0.0
0.0
2.4
2.5
2.4
502
1,227
348
Imputed
Floor
Wage
Index
Application
of the
Frontier
State Wage
Index and
Outmigration
Adjustment
AIIFY
2022
Changes
(6) 7
(7)"
(8)9
Sfmt 4725
E:\FR\FM\20OCR1.SGM
20OCR1
1.1
-0.1
-0.1
0.0
0.0
0.8
0.0
1.9
5.2
0.0
0.0
-0.6
0.9
0.2
-0.3
0.2
0.1
0.1
0.1
2.6
2.6
0.0
0.0
0.0
0.2
0.0
-0.1
0.1
0.1
-0.2
0.1
-0.1
0.0
0.1
0.2
0.2
0.1
0.2
0.0
2.7
2.5
2.6
2.5
2.5
2.5
0.0
0.0
0.0
0.0
0.0
0.1
-0.6
-0.6
-0.5
0.0
0.2
0.2
0.3
0.2
0.1
0.2
0.1
0.2
2.6
2.6
2.7
265
608
30
215
2.0
2.4
2.4
2.3
0.0
0.0
0.1
0.1
0.1
0.0
-0.1
0.3
0.2
1.0
0.1
1.0
0.0
-0.3
-0.4
-0.3
0.0
0.1
0.0
0.0
0.1
0.1
0.0
0.2
2.5
2.6
1.5
3.2
679
74
896
334
2.5
2.5
2.5
2.5
0.0
0.0
0.0
0.0
-0.1
-0.1
0.2
0.1
-0.6
-0.9
-0.5
-0.6
0.1
0.6
0.4
-0.2
0.3
0.4
0.1
0.3
0.1
0.2
0.1
0.3
2.6
2.4
2.6
2.6
523
305
153
154
27
2.5
2.0
2.1
2.1
2.2
0.0
0.0
0.1
0.0
0.0
0.0
0.1
0.0
0.1
0.0
1.0
0.1
0.0
0.5
0.7
-0.4
0.0
-0.2
-0.1
-0.2
0.1
0.0
0.1
0.0
0.1
0.1
0.0
0.1
0.0
0.0
2.6
2.5
2.6
2.2
2.2
1,881
828
486
2.5
2.5
2.4
0.0
0.0
0.0
-0.1
0.1
0.2
0.1
-0.1
-0.3
0.0
0.1
-0.1
0.2
0.1
0.0
0.1
0.1
0.0
2.6
2.6
2.5
643
2,110
367
50
2.5
2.5
2.4
2.3
0.0
0.0
0.0
0.1
0.1
0.0
-0.1
0.3
-0.6
0.1
0.2
-0.7
-0.2
0.0
0.3
-0.3
0.0
0.2
0.3
0.3
0.0
0.1
0.2
0.1
2.5
2.6
2.2
3.7
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
16:22 Oct 19, 2021
Mountain
Pacific
By Payment Classification:
Urban hosoitals
Rural areas
Teaching Status:
Nonteaching
Fewer than 100 residents
100 or more residents
UrbanDSH:
Non-DSH
100 or more beds
Less than 100 beds
RuralDSH:
SCH
RRC
100 or more beds
Less than 100 beds
Urban teaching and DSH:
Both teaching and DSH
Teaching and no DSH
No teaching and DSH
No teaching and no DSH
Special Hospital Types:
RRC
SCH
MDH
SCHandRRC
MDHandRRC
Tvoe of Ownership:
Voluntarv
Proprietarv
Government
Medicare Utilization as a Percent oflnpatient Davs:
0-25
25-50
50-65
Over65
FY2022
Weights and
DRG
Changes with
Application
of
Recalibration
Budget
Neutrality
(2)3
0.0
0.0
58029
ER20OC21.002</GPH>
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20OCR1
‘‘1.000712’’ is corrected to read
‘‘1.000715’’.
E:\FR\FM\20OCR1.SGM
2. On page 45579, third column, first
paragraph, line 23, the figure
PO 00000
ER20OC21.003</GPH>
FY 2022 Reclassifications:
All Reclassified Hospitals
Non-Reclassified Hosoitals
Urban Hospitals Reclassified
Urban Non-Reclassified Hospitals
Rural Hospitals Reclassified Full Year
Rural Non-Reclassified HosPitals Full Year
All Section 401 Reclassified Hospitals
Other Reclassified Hospitals (Section 1886(d)(8)(B))
934
2,261
749
1,723
300
423
532
56
(1)2
2.4
2.5
2.4
2.5
2.2
2.2
2.4
2.3
0.0
0.0
0.0
0.0
0.1
0.1
0.0
0.1
FY2022
Wage Data
with
Application
ofWage
Budget
Neutrality
(3) 4
0.0
0.0
0.0
0.0
0.2
0.2
0.0
0.0
FY2022
MGCRB
Reclassifications
(4) 5
1.2
-0.9
I.I
-I.I
2.0
0.0
0.8
2.4
Rural
Floor with
Application
of National
Rural
Floor
Budget
Neutrality
Imputed
Floor
Wage
Index
(5)6
(6) 7
-0.3
0.2
-0.3
0.3
-0.2
-0.2
-0.3
-0.3
0.1
0.2
0.1
0.3
0.0
0.0
0.1
0.2
Application
of the
Frontier
State Wage
Index and
Outmigration
Adjustment
(7)"
0.1
0.2
0.1
0.1
0.0
0.2
0.1
0.0
AIIFY
2022
Changes
(8)9
2.6
2.6
2.5
2.6
2.5
3.3
2.5
3.1
1 Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY 2019, and hospital cost
report data are from reporting periods beginning in FY 2018 and FY 2017.
2 This column displays the payment impact of the hospital rate update and other adjustments, including the 2.0 percent update to the national standardized amount and the hospital-specific rate (the estimated 2.7
percent market basket update reduced by 0.7 percentage point for the productivity adjustment), and the 0.5 percentage point adjustment to the national standardized amount required under section 414 of the MACRA.
3 This column displays the payment impact of the changes to the Version 39 GROUPER, the changes to the relative weights and the recalibration of the MS-DRG weights based on FY 2019 MedPAR data as the best
available data in accordance with section 1886(d)( 4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 1.000107 in accordance with section 1886(d)(4 )(C)(iii) of
the Act.
4 This column displays the payment impact of the update to wage index data using FY 2018 cost report data and the 0MB labor market area delineations based on 2010 Decennial Census data. This column displays
the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality factor, and is calculated in accordance with section 1886(d)(3)(E)(i)
of the Act. The wage budget neutrality factor is 1.000715.
5 Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY 2022 payment impact of going from no
reclassifications to the reclassifications scheduled to be in effect for FY 2022. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget
neutrality factor of0.986741.
6 This column displays the effects of the rural floor. The Affordable Care Act requires the rural floor budget neutrality adjustment to be a I 00 percent national level adjustment. The rural floor budget neutrality
factor applied to the wage index is 0.992868.
6 This column displays the effects of the imputed rural floor for all-urban states provided for under section 1886( d)(3)(E)(iv) of the Act. This is not a budget neutral policy.
8 This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a wage index no less than 1.0 and of section l 886(d)(13)
of the Act, as added by section 505 of Pub. L. 108-173, which provides for an increase in a hospital's wage index if a threshold percentage of residents of the county where the hospital is located commute to work at
hospitals in counties with higher wage indexes. These are not budget neutral policies.
9 This column shows the estimated change in payments from FY 2021 to FY 2022. This column includes the effects of the continued policy of increasing the wage index for hospitals with a wage index value below
the 25 th percentile wage index (that is, the lowest quartile wage index adjustment), the extended transition policy to place a 5-percent cap on any decrease in a hospital's wage index from its final wage index in FY
2021 (that is, the 5-percent cap), and the associated budget neutrality factors. This column reflects the budget neutrality factor of0.998029 for the lowest quartile wage index adjustment and the budget neutrality
factor of 0.999859 for the 5-percent cap for FY 2022.
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
16:22 Oct 19, 2021
BILLING CODE 4120–01–C
VerDate Sep<11>2014
Number
of
Hospitals'
Hospital
Rate
Update and
Adjustment
under
MACRA
FY2022
Weights and
DRG
Changes with
Application
of
Recalibration
Budget
Neutrality
(2) 3
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
3. On page 45580, lower three-fourths
of the page, first column, third full
paragraph, line 6, the figure ‘‘0.986737’’
is corrected to read ‘‘0.986741’’.
4. On pages 45582 and 45583, the
table titled ‘‘Table II.—Impact Analysis
of Changes for FY 2022 Acute Care
Hospital Operating Prospective Payment
58031
System (Payments Per Discharge)’’ is
corrected to read as follows:
TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2022 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT
SYSTEM
lotter on DSK11XQN23PROD with RULES1
[Payments per discharge]
Number of
hospitals
Estimated
average
FY 2021
payment per
discharge
Estimated
average
FY 2022
payment per
discharge
FY 2022
changes
(1)
(2)
(3)
(4)
All Hospitals .....................................................................................................
By Geographic Location:
Urban hospitals .........................................................................................
Rural hospitals ..........................................................................................
Bed Size (Urban):
0–99 beds .................................................................................................
100–199 beds ...........................................................................................
200–299 beds ...........................................................................................
300–499 beds ...........................................................................................
500 or more beds .....................................................................................
Bed Size (Rural):
0–49 beds .................................................................................................
50–99 beds ...............................................................................................
100–149 beds ...........................................................................................
150–199 beds ...........................................................................................
200 or more beds .....................................................................................
Urban by Region:
New England ............................................................................................
Middle Atlantic ..........................................................................................
East North Central ....................................................................................
West North Central ...................................................................................
South Atlantic ...........................................................................................
East South Central ...................................................................................
West South Central ..................................................................................
Mountain ...................................................................................................
Pacific .......................................................................................................
Puerto Rico ...............................................................................................
Rural by Region:
New England ............................................................................................
Middle Atlantic ..........................................................................................
East North Central ....................................................................................
West North Central ...................................................................................
South Atlantic ...........................................................................................
East South Central ...................................................................................
West South Central ..................................................................................
Mountain ...................................................................................................
Pacific .......................................................................................................
By Payment Classification:
Urban hospitals .........................................................................................
Rural areas ...............................................................................................
Teaching Status:
Nonteaching ..............................................................................................
Fewer than 100 residents .........................................................................
100 or more residents ..............................................................................
Urban DSH:
Non-DSH ..................................................................................................
100 or more beds .....................................................................................
Less than 100 beds ..................................................................................
Rural DSH:
SCH ..........................................................................................................
RRC ..........................................................................................................
100 or more beds .....................................................................................
Less than 100 beds ..................................................................................
Urban teaching and DSH:
Both teaching and DSH ............................................................................
Teaching and no DSH ..............................................................................
No teaching and DSH ..............................................................................
No teaching and no DSH .........................................................................
Special Hospital Types:
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3,195
13,109
13,448
2.6
2,459
736
13,454
9,901
13,800
10,178
2.6
2.8
634
754
427
421
223
10,723
11,015
12,251
13,496
16,568
11,011
11,305
12,551
13,847
16,992
2.7
2.6
2.4
2.6
2.6
311
253
94
39
39
8,556
9,419
9,789
10,519
11,465
8,921
9,644
10,033
10,788
11,784
4.3
2.4
2.5
2.6
2.8
112
304
381
160
402
144
364
172
370
50
14,858
15,432
12,838
13,121
11,710
11,290
11,806
13,698
17,230
8,491
15,253
15,814
13,150
13,475
12,049
11,576
12,072
14,054
17,664
8,637
2.7
2.5
2.4
2.7
2.9
2.5
2.3
2.6
2.5
1.7
19
50
113
89
114
144
135
48
24
13,990
9,736
10,361
10,638
9,032
8,732
8,292
12,134
13,865
14,463
9,988
10,592
10,932
9,302
8,955
8,540
12,359
14,588
3.4
2.6
2.2
2.8
3
2.6
3
1.9
5.2
1,983
1,212
12,673
13,796
13,003
14,148
2.6
2.6
2,031
907
257
10,677
12,388
18,938
10,963
12,694
19,437
2.7
2.5
2.6
502
1,227
348
11,749
13,015
9,559
12,054
13,355
9,820
2.6
2.6
2.7
265
608
30
215
11,906
14,380
12,115
7,778
12,203
14,747
12,298
8,025
2.5
2.6
1.5
3.2
679
74
896
334
14,116
12,825
10,850
10,824
14,483
13,127
11,137
11,110
2.6
2.4
2.6
2.6
E:\FR\FM\20OCR1.SGM
20OCR1
58032
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2022 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT
SYSTEM—Continued
[Payments per discharge]
Number of
hospitals
Estimated
average
FY 2021
payment per
discharge
Estimated
average
FY 2022
payment per
discharge
FY 2022
changes
(1)
(2)
(3)
(4)
RRC ..........................................................................................................
SCH ..........................................................................................................
MDH ..........................................................................................................
SCH and RRC ..........................................................................................
MDH and RRC ..........................................................................................
Type of Ownership:
Voluntary ...................................................................................................
Proprietary ................................................................................................
Government ..............................................................................................
Medicare Utilization as a Percent of Inpatient Days:
0–25 ..........................................................................................................
25–50 ........................................................................................................
50–65 ........................................................................................................
Over 65 .....................................................................................................
FY 2022 Reclassifications by the Medicare Geographic Classification Review Board:
All Reclassified Hospitals .........................................................................
Non-Reclassified Hospitals .......................................................................
Urban Hospitals Reclassified ....................................................................
Urban Nonreclassified Hospitals ..............................................................
Rural Hospitals Reclassified Full Year .....................................................
Rural Nonreclassified Hospitals Full Year ................................................
All Section 401 Reclassified Hospitals .....................................................
Other Reclassified Hospitals (Section 1886(d)(8)(B)) ..............................
5. On page 45584, bottom third of the
page, third column, partial paragraph:
a. Line 7, the figure ‘‘$151 million’’ is
corrected to read ‘‘$158 million’’.
b. Line 10, the figure ‘‘$50 million’’ is
corrected to read ‘‘$57 million’’.
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14,859
12,356
9,404
12,746
10,853
2.6
2.5
2.6
2.2
2.2
1,881
828
486
13,321
11,473
14,109
13,667
11,769
14,466
2.6
2.6
2.5
643
2,110
367
50
15,158
12,926
10,773
8,132
15,535
13,268
11,010
8,431
2.5
2.6
2.2
3.7
934
2,261
749
1,723
300
423
532
56
13,592
12,772
14,261
12,851
10,087
9,610
14,968
9,149
13,944
13,102
14,619
13,187
10,341
9,929
15,343
9,429
2.6
2.6
2.5
2.6
2.5
3.3
2.5
3.1
*
*
*
Fetroja (HABP/VABP) .................................................................
*
*
*
*
Recarbrio (HABP/VABP) .............................................................
*
*
*
379
*
*
$3,251,759.36
QIDP.
9,576.51
*
8,887,001.28
QIDP.
*
*
*
*
*
*
Abecma ......................................................................................................................
*
Jkt 256001
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Frm 00048
Fmt 4700
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*
*
*
column headings and the entries at rows
2 and 4 are corrected to read as follows:
line, the figure ‘‘$498 million’’ is
corrected to read ‘‘$514 million’’.
b. Middle third of the page, in the
untitled table, the third and fourth
Estimated cases
16:22 Oct 19, 2021
Pathway
(QIDP, LPAD, or
breakthrough
device)
$8,579.84
Technology name
VerDate Sep<11>2014
Estimated FY
2022 total impact
*
928
*
6. On page 45585:
a. Top third of the page:
(1) In the untitled table, the third and
fourth column headings and the entries
at rows 6 and 9 are corrected to read as
follows:
FY 2022 NTAP
amount
Estimated cases
(2) Following the first untitled table,
second column, partial paragraph, last
14,478
12,053
9,169
12,475
10,622
c. Lines 15 and 16, the phrase ‘‘for
which we are approving new technology
add-on payments’’ is corrected to read
‘‘for which we are approving or
conditionally approving new technology
add-on payments’’.
Technology name
*
523
305
153
154
27
484
E:\FR\FM\20OCR1.SGM
FY 2022 NTAP
amount
*
$272,675.00
20OCR1
Estimated FY
2022 total impact
*
$131,974,700.00
58033
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
Technology name
Estimated cases
*
*
*
*
Tecartus .....................................................................................................................
*
*
*
*
lotter on DSK11XQN23PROD with RULES1
7. On pages 45587 and 45588, the
table titled ‘‘Modeled Uncompensated
Care Payments for Estimated FY 2022
VerDate Sep<11>2014
16:22 Oct 19, 2021
Jkt 256001
*
259,350.00
15
*
*
DSHs by Hospital Type: Model
Uncompensated Care Payments ($ in
PO 00000
FY 2022 NTAP
amount
*
Fmt 4700
Sfmt 4700
*
3,890,250.00
*
Millions)—from FY 2021 to FY 2022’’ is
corrected to read as follows:
BILLING CODE 4120–01–P
Frm 00049
Estimated FY
2022 total impact
E:\FR\FM\20OCR1.SGM
20OCR1
58034
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
Total
By Geographic Location
Urban Hospitals
Large Urban Areas
Other Urban Areas
Rural Hospitals
Bed Size (Urban)
0 to 99 Beds
100 to 249 Beds
250+ Beds
Bed Size (Rural)
0 to 99 Beds
100 to 249 Beds
250+ Beds
Urban bv Re2ion
New England
Middle Atlantic
South Atlantic
East North Central
East South Central
West North Central
West South Central
Mountain
Pacific
Puerto Rico
Rural by Region
New England
Middle Atlantic
South Atlantic
East North Central
East South Central
West North Central
West South Central
Mountain
Pacific
Bv Pavment Classification
Urban Hospitals
Large Urban Areas
Other Urban Areas
Rural Hospitals
Teaching Status
N onteaching
Fewer than 100 residents
100 or more residents
Tvpe of Ownership
Voluntarv
Proprietarv
VerDate Sep<11>2014
16:22 Oct 19, 2021
Jkt 256001
Number of
Estimated
DSHs
FY 2021 Final
Rule Estimated
Uncompensated
Care Payments
($ in millions)
FY 2022 Final
Rule Estimated
Uncompensated
Care Payments
($ in millions)
Dollar Difference:
FY 2021-FY 2022
($ in millions)
(1)
(2)
(3)
(4)
Percent
Change**
(5)
2,365
8,290
7,192
-1098
-13.24%
1,900
989
911
465
7,803
4,829
2,974
487
6,789
4,146
2,643
403
-1014
-683
-331
-84
-12.99
-14.15
-11.12
-17.28
325
818
757
290
1,898
5,615
245
1,603
4,940
-45
-294
-675
-15.49
-15.50
-12.02
352
100
13
269
166
52
218
141
45
-51
-26
-7
-18.97
-15.53
-14.16
92
230
313
98
312
126
241
132
315
41
227
983
864
405
2,027
498
1,637
333
723
107
186
819
800
354
1,759
439
1,434
299
607
93
-40
-163
-64
-51
-268
-59
-204
-34
-116
-14
-17.79
-16.62
-7.44
-12.58
-13.2
-11.92
-12.44
-10.32
-15.99
-13.01
8
21
65
28
83
124
107
24
5
15
15
58
31
135
102
105
19
7
15
12
43
23
117
85
88
14
5
0
-3
-15
-8
-18
-18
-17
-5
-2
-1.27
-17.92
-25.28
-25.87
-13.01
-17.22
-15.92
-25.92
-25.68
1,506
850
656
859
5,470
3,614
1,855
2,820
4,773
3,125
1,648
2,419
-697
-489
-208
-401
-12.74
-13.52
-11.21
-14.23
1,370
742
253
2,444
2,865
2,980
2,116
2,494
2,581
-328
-371
-399
-13.4
-12.94
-13.39
1,422
575
4,556
1,217
3,981
1,076
-574
-141
-12.61
-11.56
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E:\FR\FM\20OCR1.SGM
20OCR1
ER20OC21.004</GPH>
lotter on DSK11XQN23PROD with RULES1
Modeled Uncompensated Care Payments for Estimated FY 2022 DSHs by Hospital Type: Model
Uncompensated Care Payments($ in Millions)* - from FY 2021 to FY 2022
58035
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
Modeled Uncompensated Care Payments for Estimated FY 2022 DSHs by Hospital Type: Model
Uncompensated Care Payments($ in Millions)* - from FY 2021 to FY 2022
Number of
Estimated
DSHs
(1)
368
FY 2021 Final
Rule Estimated
Uncompensated
Care Payments
($ in millions)
(2)
2,517
FY 2022 Final
Rule Estimated
Uncompensated
Care Payments
($ in millions)
(3)
2,134
Dollar Difference:
FY 2021 - FY 2022
($ in millions)
(4)
-383
Percent
Change**
(5)
-15.21
2,940
4,098
150
4
-448
-609
-39
-2
-13.22
-12.94
-20.85
-32.86
Government
Medicare Utilization Percent***
0 to 25
554
3,388
25 to 50
1,602
4,707
187
189
50 to 65
22
6
Greater than 65
Source: Dobson I Davanzo analysis of2013 and 2018 Hospital Cost Reports.
lotter on DSK11XQN23PROD with RULES1
BILLING CODE 4120–01–C
8. On page 45588, lower half of the
page, beginning with the second
column, first full paragraph, line 1 with
the phrase ‘‘Rural hospitals, in general,
are projected to experience’’ and ending
in the third column last paragraph with
the phrase ‘‘15.22 percent. All’’ the
paragraphs are corrected to read as
follows:
‘‘Rural hospitals, in general, are
projected to experience larger decreases
in uncompensated care payments than
their urban counterparts. Overall, rural
hospitals are projected to receive a 17.28
percent decrease in uncompensated care
payments, which is a greater decrease
than the overall hospital average, while
urban hospitals are projected to receive
a 12.99 percent decrease in
uncompensated care payments, similar
to the overall hospital average.
By bed size, smaller rural hospitals
are projected to receive the largest
decreases in uncompensated care
payments. Rural hospitals with 0–99
beds are projected to receive an 18.97
percent payment decrease, and rural
hospitals with 100–249 beds are
projected to receive a 15.53 percent
decrease. In contrast, larger rural
hospitals with 250+ beds are projected
to receive a 14.16 percent payment
decrease. Among urban hospitals, the
smallest urban hospitals, those with 0–
99 and 100–249 beds, are projected to
receive a decrease in uncompensated
care payments that is greater than the
overall hospital average, at 15.49 and
15.50 percent, respectively. In contrast,
the largest urban hospitals with 250+
VerDate Sep<11>2014
16:22 Oct 19, 2021
Jkt 256001
beds are projected to receive a 12.02
percent decrease in uncompensated care
payments, which is a smaller decrease
than the overall hospital average.
By region, rural hospitals are expected
to receive larger than average decreases
in uncompensated care payments in all
Regions, except for rural hospitals in
New England, which are projected to
receive a decrease of 1.27 percent in
uncompensated care payments, and
rural hospitals in the East South Central
Region, which are projected to receive a
smaller than average decrease of 13.01
percent. Regionally, urban hospitals are
projected to receive a more varied range
of payment changes. Urban hospitals in
the New England, Middle Atlantic, and
Pacific Regions are projected to receive
larger than average decreases in
uncompensated care payments. Urban
hospitals in the South Atlantic, East
North Central, West North Central, West
South Central, and Mountain Regions,
as well as hospitals in Puerto Rico are
projected to receive smaller than
average decreases in uncompensated
care payments. Urban hospitals in the
East South Central Region are projected
to receive an average decrease in
uncompensated care payments.
By payment classification, although
hospitals in urban areas overall are
expected to receive a 12.74 percent
decrease in uncompensated care
payments, hospitals in large urban areas
are expected to see a decrease in
uncompensated care payments of 13.52
percent, while hospitals in other urban
areas are expected to receive a decrease
in uncompensated care payments of
PO 00000
Frm 00051
Fmt 4700
Sfmt 4700
11.21 percent. Rural hospitals are
projected to receive the largest decrease
of 14.23 percent.
Nonteaching hospitals are projected to
receive a payment decrease of 13.4
percent, teaching hospitals with fewer
than 100 residents are projected to
receive a payment decrease of 12.94
percent, and teaching hospitals with
100+ residents have a projected
payment decrease of 13.39 percent. All
of these decreases closely approximate
the overall hospital average. Proprietary
and voluntary hospitals are projected to
receive smaller than average decreases
of 11.56 and 12.61 percent respectively,
while government hospitals are
expected to receive a larger payment
decrease of 15.21 percent. All’’.
9. On page 45589, first column, first
partial paragraph, the phrase ‘‘hospitals
with less than 50 percent Medicare
utilization are projected to receive
decreases in uncompensated care
payments consistent with the overall
hospital average percent change, while
hospitals with 50–65 percent and
greater than 65 percent Medicare
utilization are projected to receive larger
decreases of 20.79 and 32.81 percent,
respectively.’’ is corrected to read as
follows: ‘‘hospitals with less than 50
percent Medicare utilization are
projected to receive decreases in
uncompensated care payments
consistent with the overall hospital
average percent change, while hospitals
with 50–65 percent and greater than 65
percent Medicare utilization are
projected to receive larger decreases of
20.85 and 32.86 percent, respectively.’’
E:\FR\FM\20OCR1.SGM
20OCR1
ER20OC21.005</GPH>
*Dollar uncompensated care payments calculated by [0.75 * estimated section 1886(d)(5)(F) payments* Factor 2 * Factor 3].
When summed across all hospitals projected to receive DSH payments, uncompensated care payments are estimated to be $8,290
million in FY 2021 and $7, 192 million in FY 2022.
* * Percentage change is determined as the difference between Medicare uncompensated care payments modeled for this FY 2022
IPPS/L TCH PPS final rule (column 3) and Medicare uncompensated care payments modeled for the FY 2021 IPPS/L TCH PPS
final rule correction notice (column 2) divided by Medicare uncompensated care payments modeled for the FY 2021 IPPS/L TCH
PPS final rule correction notice (column 2) times 100 percent.
***Hospitals with missing or unknown Medicare utilization are not shown in table.
58036
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
lotter on DSK11XQN23PROD with RULES1
10. On page 45598, third column, last
paragraph, lines 21 through 23, the
sentence ‘‘The estimated percentage
increase for both rural reclassified and
nonreclassified hospitals is 1.4
percent.’’ is corrected to read ‘‘The
estimated percentage increase for rural
VerDate Sep<11>2014
16:22 Oct 19, 2021
Jkt 256001
reclassified hospitals is 1.3 percent,
while the estimated percentage increase
for rural nonreclassified hospitals is 1.4
percent.’’
11. On pages 45599 and 45600, the
table titled ‘‘TABLE III.—COMPARISON
OF TOTAL PAYMENTS PER CASE [FY
PO 00000
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Fmt 4700
Sfmt 4700
2021 PAYMENTS COMPARED TO FY
2022 PAYMENTS]’’ is corrected to read
as follows:
BILLING CODE 4120–01–P
E:\FR\FM\20OCR1.SGM
20OCR1
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
VerDate Sep<11>2014
16:22 Oct 19, 2021
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E:\FR\FM\20OCR1.SGM
20OCR1
Change
0.9
0.9
1.5
1.2
1.3
1.1
0.9
0.5
1.6
1.3
1.4
1.8
1.6
1.5
0.4
1.5
0.9
0.7
0.5
0.2
0.9
0.8
1.7
1.7
2.2
0.9
1.0
1.1
2.3
1.0
0.8
1.3
0.1
1.3
0.9
ER20OC21.006</GPH>
lotter on DSK11XQN23PROD with RULES1
TABLE 111.--COMPARISON OF TOTAL PAYMENTS PER CASE
[FY 2021 PAYMENTS COMPARED TO FY 2022 PAYMENTS]
Average Average
Number of FY 2021 FY2022
Hospitals Payments/ Payments/
Case
Case
All hospitals
981
990
3,195
By Geographic Location:
Urban Hospitals
2,459
1,014
1,023
Rural areas
736
673
683
Bed Size (Urban)
0-99 beds
634
803
813
100-199 beds
754
871
860
200-299 beds
427
949
939
300-499 beds
421
1,020
1,029
500 or more beds
223
1,215
1,221
Bed Size (Rural)
0-49 beds
311
568
577
50-99 beds
253
626
634
100-149 beds
94
666
675
150-199 beds
39
737
750
200 or more beds
39
797
810
By Region:
Urban by Region
New England
112
1,104
1,121
Middle Atlantic
304
1,129
1,134
South Atlantic
402
889
902
East North Central
381
966
975
East South Central
144
863
869
West North Central
160
994
989
West South Central
364
927
929
Mountain
172
1,023
1,032
Pacific
1,304
1,314
370
Rural by Region
New England
19
937
953
Middle Atlantic
50
651
662
South Atlantic
114
623
637
East North Central
113
681
687
East South Central
144
630
636
West North Central
89
701
709
West South Central
135
602
616
Mountain
48
765
773
Pacific
24
869
876
By Payment Classification:
Urban hospitals
1,983
982
995
Rural areas
1,212
980
981
Teaching Status:
Non-teaching
2,031
817
828
Fewer than 100 Residents
941
949
907
58037
58038
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
TABLE 111.--COMPARISON OF TOTAL PAYMENTS PER CASE
rFY 2021 PAYMENTS COMPARED To FY 2022 PAYMENTS
Average Average
Number of FY 2021
FY2022
Hospitals Payments/ Payments/
Case
Case
100 or more Residents
257
1,358
1,365
UrbanDSH:
Non-DSH
502
904
915
1,008
1,022
100 or more beds
1,227
Less than 100 beds
348
728
737
OClural DSH:
Sole Community (SCH/EACH)
265
751
750
Referral Center (RRC/EACH)
608
1,030
1,031
lotter on DSK11XQN23PROD with RULES1
Medicare Utilization as a Percent of Inpatient Days:
0-25
25-50
50-65
Over65
~022 Reclassifications by the Medicare
Classification Review Board:
All Reclassified Hospitals
All Nomeclassified Hospitals
Urban Hospitals Reclassified
Urban Nomeclassified Hospitals
Rural Hospitals Reclassified Full Year
Rural Nomeclassified Hospitals Full Year
All Section 401 Reclassified Hospitals
Other Reclassified Hospitals (Section 1886(d)(8)(B))
12. On page 45610:
a. Second column, first partial
paragraph:
(1) Line 1, the figure ‘‘$2.293’’ is
corrected to read ‘‘$2.316’’.
(2) Line 11, the figure ‘‘$0.65’’ is
corrected to read ‘‘$0.68’’.
VerDate Sep<11>2014
16:22 Oct 19, 2021
Jkt 256001
Frm 00054
Fmt 4700
Sfmt 4700
1.2
1.4
1.2
-0.1
0.1
-2.2
1.4
30
215
895
559
875
567
679
74
896
334
1,075
981
866
859
1,090
993
878
870
1.4
1.2
1.4
152
523
305
153
154
27
781
1,061
758
610
807
687
775
1,063
758
615
815
694
-0.8
0.2
0.0
0.8
1.0
1.0
1,881
828
486
993
896
1,031
1,002
905
1,035
0.9
1.0
0.4
643
2,110
367
50
1,119
972
797
586
1,125
981
804
596
0.5
0.9
0.9
1.7
934
2,261
749
1,723
300
423
532
56
987
977
1,039
995
695
641
1,073
662
993
988
1,042
1,008
704
650
1,072
672
0.6
b. Third column, last full paragraph,
last line, the figure ‘‘$2.293’’ is corrected
to read ‘‘$2.316’’.
13. On page 45611, the table titled
‘‘Table V—ACCOUNTING
STATEMENT: CLASSIFICATION OF
ESTIMATED EXPENDITURES UNDER
PO 00000
0.5
1.3
1.1
0.3
1.3
1.3
1.4
-0.1
1.5
THE IPPS FROM FY 2021 TO FY 2022’’
is corrected to read as follows:
E:\FR\FM\20OCR1.SGM
20OCR1
ER20OC21.007</GPH>
100 or more beds
Less than 100 beds
Urban teaching and DSH:
Both teaching and DSH
Teaching and no DSH
No teaching and DSH
No teaching and no DSH
Special Hospital Types:
Non special status hospitals
RRC/EACH
SCH/EACH
Medicare-dependent hospitals (MDH)
SCH, RRC and EACH
MDH, RRC and EACH
Type of Ownership:
Voluntarv
Proprietarv
Government
Change
Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations
Category
Annualized
Monetized
Transfers.
From Whom to
Whom.
report is not rejected if the requirement
in paragraph (f)(5)(i)(A)(2)(i) of this
section is not met.
*
*
*
*
*
Transfers
$2.316 billion.
Federal Government to IPPS
Medicare Providers.
List of Subjects in 42 CFR Part 413
[FR Doc. 2021–22724 Filed 10–19–21; 8:45 am]
Diseases, Health facilities, Medicare,
Puerto Rico, Reporting and
recordkeeping requirements.
As noted in section II.B. of the
preamble, the Centers for Medicare &
Medicaid Services is making the
following correcting amendments to 42
CFR part 413:
PART 413—PRINCIPLES OF
REASONABLE COST
REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE
SERVICES; OPTIONAL
PROSPECTIVELY DETERMINED
PAYMENT RATES FOR SKILLED
NURSING FACILITIES
2. Amend § 413.24 by:
a. In paragraph (f)(5)(i) introductory
text, removing the phrase ‘‘except as
provided in paragraph (f)(5)(i)(E) of this
section:’’ and adding in its place the
phrase ‘‘except as provided in
paragraphs (f)(5)(i)(A)(2)(ii) and
(f)(5)(i)(E) of this section:’’; and
■ b. Revising paragraph (f)(5)(i)(A).
The revision reads as follows:
Adequate cost data and cost
lotter on DSK11XQN23PROD with RULES1
*
*
*
*
(f) * * *
(5) * * *
(i) * * *
(A) Teaching hospitals. For teaching
hospitals, the Intern and Resident
Information System (IRIS) data.
(1) Data format. For cost reporting
periods beginning on or after October 1,
2021, the IRIS data must be in the new
XML IRIS format.
(2) Resident counts. (i) Effective for
cost reporting periods beginning on or
after October 1, 2021, the IRIS data must
contain the same total counts of direct
GME FTE residents (unweighted and
weighted) and IME FTE residents as the
total counts of direct GME FTE and IME
FTE residents reported in the provider’s
cost report.
(ii) For cost reporting periods
beginning on or after October 1, 2021,
and before October 1, 2022, the cost
Jkt 256001
[WC Docket No. 17–97; FCC 20–136; FRS
52215]
In this document, the
Commission announces the effective
date of an information collection
associated with a rule contained in the
Commission’s Call Authentication Trust
Anchor, Second Report and Order
(Order). This document is consistent
with the Commission’s Call
Authentication Trust Anchor, Second
Report and Order (Order) which stated
that the Commission would publish a
document in the Federal Register
announcing the effective date of that
rule.
SUMMARY:
■
■
16:22 Oct 19, 2021
47 CFR Part 64
Federal Communications
Commission.
ACTION: Final rule; announcement of
effective date.
Authority: 42 U.S.C. 1302, 1395d(d),
1395f(b), 1395g, 1395l(a), (i), and (n),
1395x(v), 1395hh, 1395rr, 1395tt, and
1395ww.
VerDate Sep<11>2014
FEDERAL COMMUNICATIONS
COMMISSION
AGENCY:
1. The authority citation for part 413
continues to read as follows:
*
BILLING CODE 4120–01–C
Call Authentication Trust Anchor
■
§ 413.24
finding.
Karuna Seshasai,
Executive Secretary to the Department,
Department of Health and Human Services.
The amendment to 47 CFR
64.6306(e) (instruction 11), published
November 17, 2020 (85 FR 73360), and
delayed indefinitely, is effective October
20, 2021. This final rule is effective
October 20, 2021.
FOR FURTHER INFORMATION CONTACT: For
further information, please contact
Alexander Hobbs, Competition Policy
Division, Wireline Competition Bureau
at (202) 418–7433 or by email at
Alexander.Hobbs@fcc.gov.
SUPPLEMENTARY INFORMATION: On June 4,
2021, the Commission announced OMB
approval of § 64.6306(e) in a Federal
Register publication, at 86 FR 29952.
This document now announces the
effective date of § 64.6306(e). In the
Order and the text of § 64.6306(e), the
Commission directed the Wireline
Competition Bureau to set the
compliance date for this rule. On
September 3, 2021, the Bureau released
a Public Notice, DA 21–1103, setting the
date by which voice service providers
granted an exemption from the
Commission’s caller ID authentication
rule must file implementation
DATES:
PO 00000
Frm 00055
Fmt 4700
Sfmt 4700
58039
verification certifications and associated
supporting statements. Voice service
providers must file all certifications and
associated supporting statements
electronically in WC Docket No. 20–68,
Exemption from Caller ID
Authentication Requirements, in ECFS,
no later than October 4, 2021. We
therefore modify the text of
§ 64.6306(e), previously published at 85
FR 73360, to incorporate this
compliance date announced by the
Bureau.
If you have any comments on the
burden estimates listed below, or how
the Commission can improve the
collections and reduce any burdens
caused thereby, please contact Nicole
Ongele, Federal Communications
Commission, Room 3.310, 45 L Street
NE, Washington, DC 20002. Please
include the OMB Control Number,
3060–1285, in your correspondence.
The Commission will also accept your
comments via email at PRA@fcc.gov.
To request materials in accessible
formats for people with disabilities (e.g.,
Braille, large print, electronic files,
audio format, etc.), send an email to
fcc504@fcc.gov or call the Consumer &
Governmental Affairs Bureau at (202)
418–0530 (voice), or (202) 418–0432
(TTY).
Synopsis
As required by the Paperwork
Reduction Act of 1995 (44 U.S.C. 3507),
the FCC is notifying the public that it
received final OMB approval on May 13,
2021, for the information collection
requirements contained in the
modifications to the Commission’s rules
in 47 CFR part 64 and modifying the
language of § 64.6306(e) to conform to
the compliance date adopted by the
Wireline Competition Bureau in DA 21–
1103.
Under 5 CFR part 1320, an agency
may not conduct or sponsor a collection
of information unless it displays a
current, valid OMB Control Number.
No person shall be subject to any
penalty for failing to comply with a
collection of information subject to the
Paperwork Reduction Act that does not
display a current, valid OMB Control
Number. The OMB Control Number is
3060–1285.
The foregoing is required by the
Paperwork Reduction Act of 1995,
Public Law 104–13, October 1, 1995,
and 44 U.S.C. 3507.
The total annual reporting burdens
and costs for the respondents are as
follows:
OMB Control Number: 3060–1285.
OMB Approval Date: May 13, 2021.
OMB Expiration Date: May 31, 2024.
E:\FR\FM\20OCR1.SGM
20OCR1
]]>Agencies
[Federal Register Volume 86, Number 200 (Wednesday, October 20, 2021)]
[Rules and Regulations]
[Pages 58019-58039]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-22724]
[[Page 58019]]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 412, 413, 425, 455, and 495
[CMS-1752-F2 and CMS-1762-F2]
RIN 0938-AU44 and 0938-AU56
Medicare Program; Hospital Inpatient Prospective Payment Systems
for Acute Care Hospitals and the Long-Term Care Hospital Prospective
Payment System and Policy Changes and Fiscal Year 2022 Rates; Quality
Programs and Medicare Promoting Interoperability Program Requirements
for Eligible Hospitals and Critical Access Hospitals; Changes to
Medicaid Provider Enrollment; and Changes to the Medicare Shared
Savings Program; Corrections
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Final rule; correction and correcting amendment.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical and typographical errors in
the final rule that appeared in the August 13, 2021, issue of the
Federal Register titled ``Medicare Program; Hospital Inpatient
Prospective Payment Systems for Acute Care Hospitals and the Long Term
Care Hospital Prospective Payment System and Policy Changes and Fiscal
Year 2022 Rates; Quality Programs and Medicare Promoting
Interoperability Program Requirements for Eligible Hospitals and
Critical Access Hospitals; Changes to Medicaid Provider Enrollment; and
Changes to the Medicare Shared Savings Program.''
DATES:
Effective date: The final rule corrections and correcting amendment
are effective on October 19, 2021.
Applicability date: The final rule corrections and correcting
amendment are applicable to discharges occurring on or after October 1,
2021.
FOR FURTHER INFORMATION CONTACT: Donald Thompson, (410) 786-4487, and
Michele Hudson, (410) 786-4487, Operating Prospective Payment, Wage
Index, Hospital Geographic Reclassifications, Medicare Disproportionate
Share Hospital (DSH) Payment Adjustment, Graduate Medical Education,
and Critical Access Hospital (CAH) Issues. Mady Hue, (410) 786-4510,
and Andrea Hazeley, (410) 786-3543, MS-DRG Classification Issues.
Allison Pompey, (410) 786-2348, New Technology Add-On Payments
Issues. Julia Venanzi, [email protected], Hospital Inpatient
Quality Reporting and Hospital Value-Based Purchasing Programs.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2021-16519 of August 13, 2021 (86 FR 44774), there were
a number of technical and typographical errors that are identified and
corrected in this final rule correction and correcting amendment. The
final rule corrections and correcting amendment are applicable to
discharges occurring on or after October 1, 2021, as if they had been
included in the document that appeared in the August 13, 2021, Federal
Register.
II. Summary of Errors
A. Summary of Errors in the Preamble
On page 44878, we are correcting an inadvertent error in the
reference to the number of technologies for which we proposed to allow
a one-time extension of new technology add-on payments for fiscal year
(FY) 2022.
On page 44889, we are correcting an inadvertent typographical error
in the International Classification of Disease, 10th Revision,
Procedure Coding System (ICD-10-PCS) procedure code describing the
percutaneous endoscopic repair of the esophagus.
On page 44960, in the table displaying the Medicare-Severity
Diagnosis Related Groups (MS-DRGs) subject to the policy for replaced
devices offered without cost or with a credit for FY 2022, we are
correcting inadvertent typographical errors in the MS-DRGs describing
Hip Replacement with Principal Diagnosis of Hip Fracture with and
without MCC, respectively.
On pages 45047, 45048, and 45049, in our discussion of the new
technology add-on payments for FY 2022, we are correcting typographical
and technical errors in referencing sections of the final rule.
On page 45133, we are correcting an error in the maximum new
technology add-on payment for a case involving the use of
AprevoTM Intervertebral Body Fusion Device.
On page 45150, we inadvertently omitted ICD-10-CM codes from the
list of diagnosis codes used to identify cases involving the use of the
INTERCEPT Fibrinogen Complex that would be eligible for new technology
add-on payments.
On page 45157, we inadvertently omitted the ICD-10-CM diagnosis
codes used to identify cases involving the use of FETROJA[supreg] for
HABP/VABP.
On page 45158, we inadvertently omitted the ICD-10-CM diagnosis
codes used to identify cases involving the use of
RECARBRIOTM for HABP/VABP.
On pages 45291, 45293, and 45294, in three tables that display
previously established, newly updated, and estimated performance
standards for measures included in the Hospital Value-Based Purchasing
Program, we are correcting errors in the numerical values for all
measures in the Clinical Outcomes Domain that appear in the three
tables.
On page 45312, in our discussion of payments for indirect and
direct graduate medical education costs and Intern and Resident
Information System (IRIS) data, we made a typographical error in our
response to a comment.
On page 45386, we made an inadvertent typographical error in our
discussion of the Hospital Inpatient Quality Reporting (IQR) Program
Severe Hyperglycemia electronic clinical quality measure (eCQM).
On page 45400, in our discussion of the Hospital Inpatient Quality
Reporting (IQR) Program measures for fiscal year (FY) 2024, we
mislabeled the table title and inadvertently included a measure not
pertaining to the FY 2024 payment determination along with its
corresponding footnote.
On page 45404, in our discussion the Hospital Inpatient Quality
Reporting (IQR) Program, we included a table with the measures for the
FY 2025 payment determination. In the notes that immediately followed
the table, we made a typographical error in the date associated with
the voluntary reporting period for the Hybrid Hospital-Wide All-Cause
Risk Standardized Mortality (HWM) measure.
B. Summary of Errors in the Regulations Text
On page 45521, in the regulations text for Sec. 413.24(f)(5)(i)
introductory text and (f)(5)(i)(A) regarding cost reporting forms and
teaching hospitals, we inadvertently omitted revisions that were
discussed in the preamble.
C. Summary of Errors in the Addendum
In the FY 2022 Hospital Inpatient Prospective Payment Systems and
Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS)
final rule (85 FR 45166), we stated that we excluded the wage data for
critical access hospitals (CAHs) as discussed in the FY 2004 IPPS final
rule (68 FR 45397 through 45398); that is, any hospital that is
designated as a CAH by 7 days prior to the publication of the
preliminary wage index public use file (PUF) is excluded from the
calculation
[[Page 58020]]
of the wage index. We inadvertently excluded a hospital that converted
to CAH status after January 24, 2021, the cut-off date for CAH
exclusion from the FY 2022 wage index. (CMS Certification Number (CCN)
230118) Therefore, we restored the wage data for this hospital and
included it in our calculation of the wage index. This correction
necessitated the recalculation of the FY 2022 wage index for rural
Michigan (rural state code 23), as reflected in Table 3, and affected
the final FY 2022 wage index for rural Michigan 23 as well as the rural
floor for the State of Michigan. As discussed in this section, the
final FY 2022 IPPS wage index is used when determining total payments
for purposes of all budget neutrality factors (except for the MS-DRG
reclassification and recalibration budget neutrality factor) and the
final outlier threshold.
We note, in the final rule, we correctly listed the number of
hospitals with CAH status removed from the FY 2022 wage index (86 FR
45166), the number of hospitals used for the FY 2022 wage index (86 FR
45166) and the number of hospital occupational mix surveys used for the
FY 2022 wage index (86 FR 45173). Additionally, the FY 2022 national
average hourly wage (unadjusted for occupational mix) (86 FR 45172),
the FY 2022 occupational mix adjusted national average hourly wage (86
FR 45173), and the FY 2022 national average hourly wages for the
occupational mix nursing subcategories (86 FR 45174) listed in the
final rule remain unchanged. Because the numbers and values noted
previously are correctly stated in the preamble of the final rule and
remain unchanged, we do not include any corrections in section IV.A. of
this final rule correction and correcting amendment.
We made an inadvertent error in the Medicare Geographic
Classification Review Board (MGCRB) reclassification status of one
hospital in the FY 2022 IPPS/LTCH PPS final rule. Specifically, CCN
360259 is incorrectly listed in Table 2 as reclassified to CBSA 19124.
The correct reclassification area is to its geographic ``home'' of CBSA
45780. This correction necessitated the recalculation of the FY 2022
wage index for CBSA 19124 and affected the final FY 2022 wage index
with reclassification. The final FY 2022 IPPS wage index with
reclassification is used when determining total payments for purposes
of all budget neutrality factors (except for the MS-DRG
reclassification and recalibration budget neutrality factor and the
wage index budget neutrality adjustment factor) and the final outlier
threshold.
As discussed further in section II.E. of this final rule correction
and correcting amendment, we made updates to the calculation of Factor
3 of the uncompensated care payment methodology to reflect updated
information on hospital mergers received in response to the final rule
and made corrections for report upload errors. Factor 3 determines the
total amount of the uncompensated care payment a hospital is eligible
to receive for a fiscal year. This hospital-specific payment amount is
then used to calculate the amount of the interim uncompensated care
payments a hospital receives per discharge. Per discharge uncompensated
care payments are included when determining total payments for purposes
of all of the budget neutrality factors and the final outlier
threshold. As a result, the revisions made to the calculation of Factor
3 to address additional merger information and report upload errors
directly affected the calculation of total payments and required the
recalculation of all the budget neutrality factors and the final
outlier threshold.
Due to the correction of the combination of errors that are
discussed previously (correcting the number of hospitals with CAH
status, the correction to the MGCRB reclassification status of one
hospital, and the revisions to Factor 3 of the uncompensated care
payment methodology), we recalculated all IPPS budget neutrality
adjustment factors, the fixed-loss cost threshold, the final wage
indexes (and geographic adjustment factors (GAFs)), the national
operating standardized amounts and capital Federal rate. We note that
the fixed-loss cost threshold was unchanged after these recalculations.
Therefore, we made conforming changes to the following:
On page 45532, the table titled ``Summary of FY 2022
Budget Neutrality Factors''.
On page 45537, the estimated total Federal capital
payments and the estimated capital outlier payments.
On pages 45542 and 45543, the calculation of the outlier
fixed-loss cost threshold, total operating Federal payments, total
operating outlier payments, the outlier adjustment to the capital
Federal rate and the related discussion of the percentage estimates of
operating and capital outlier payments.
On page 45545, the table titled ``Changes from FY 2021
Standardized Amounts to the FY 2022 Standardized Amounts''.
On pages 45553 through 45554, in our discussion of the
determination of the Federal hospital inpatient capital related
prospective payment rate update, due to the recalculation of the GAFs,
we have made conforming corrections to the capital Federal rate. As a
result of these changes, we also made conforming corrections in the
table showing the comparison of factors and adjustments for the FY 2021
capital Federal rate and FY 2022 capital Federal rate. As we noted in
the final rule, the capital Federal rate is calculated using unrounded
budget neutrality and outlier adjustment factors. The unrounded GAF/DRG
budget neutrality factor, the unrounded Quartile/Cap budget neutrality
factor, and the unrounded outlier adjustment to the capital Federal
rate were revised because of these errors. However, after rounding
these factors to 4 decimal places as displayed in the final rule, the
rounded factors were unchanged from the final rule.
On pages 45570 and 45571, we are making conforming corrections to
the national adjusted operating standardized amounts and capital
standard Federal payment rate (which also include the rates payable to
hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a
result of the conforming corrections to certain budget neutrality
factors, as previously described.
D. Summary of Errors in the Appendices
On pages 45576 through 45580, 45582 through 45583, and 45598
through 45600, in our regulatory impact analyses, we have made
conforming corrections to the factors, values, and tables and
accompanying discussion of the changes in operating and capital IPPS
payments for FY 2022 and the effects of certain IPPS budget neutrality
factors as a result of the technical errors that lead to changes in our
calculation of the operating and capital IPPS budget neutrality
factors, outlier threshold, final wage indexes, operating standardized
amounts, and capital Federal rate (as described in section II.C. of
this final rule correction and correcting amendment). These conforming
corrections include changes to the following:
On pages 45576 through 45578, the table titled ``Table I--
Impact Analysis of Changes to the IPPS for Operating Costs for FY
2022''.
On pages 45582 and 45583, the table titled ``Table II--
Impact Analysis of Changes for FY 2022 Acute Care Hospital Operating
Prospective Payment System (Payments per discharge)''.
On pages 45599 and 45600, the table titled ``Table III--
Comparison of
[[Page 58021]]
Total Payments per Case [FY 2021 Payments Compared to FY 2022
Payments]''.
On pages 45584 and 45585 we are correcting the maximum new-
technology add-on payment for a case involving the use of Fetroja,
Recarbrio, Tecartus, and Abecma and related information in the untitled
tables as well as making conforming corrections to the total estimated
FY 2022 payments in the accompanying discussion of applications
approved or conditionally approved for new technology add-on payments.
On pages 45587 through 45589, we are correcting the discussion of
the ``Effects of the Changes to Medicare DSH and Uncompensated Care
Payments for FY 2022'' for purposes of the Regulatory Impact Analysis
in Appendix A of the FY 2022 IPPS/LTCH PPS final rule, including the
table titled ``Modeled Uncompensated Care Payments for Estimated FY
2022 DSHs by Hospital Type: Uncompensated Care Payments ($ in
Millions)*--from FY 2021 to FY 2022'', in light of the corrections
discussed in section II.E. of this final rule correction and correcting
amendment.
On pages 45610 and 45611, we are making conforming corrections to
the estimated expenditures under the IPPS as a result of the
corrections to the maximum new technology add-on payment for a case
involving the use of AprevoTM Intervertebral Body Fusion
Device, Fetroja, Recarbrio, Abecma, and Tecartus as described in this
section and in section II.A. of this final rule correction and
correcting amendment.
E. Summary of Errors in and Corrections to Files and Tables Posted on
the CMS Website
We are correcting the errors in the following IPPS tables that are
listed on pages 45569 and 45570 of the FY 2022 IPPS/LTCH PPS final rule
and are available on the internet on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/. The tables that are available on the
internet have been updated to reflect the revisions discussed in this
final rule correction and correcting amendment.
Table 2--Case-Mix Index and Wage Index Table by CCN-FY 2022 Final
Rule. As discussed in section II.C. of this final rule correction and
correcting amendment, we inadvertently excluded a hospital that
converted to CAH status after January 24, 2021, the cut-off date for
CAH exclusion from the FY 2022 wage index. (CMS Certification Number
(CCN) 230118). Therefore, we restored provider 230118 to the table.
Also, as discussed in section II.C. of this final rule correction and
correcting amendment, CCN 360259 is incorrectly listed as reclassified
to CBSA 19124. The correct reclassification area is to its geographic
``home'' of CBSA 45780. In this table, we are correcting the columns
titled ``Wage Index Payment CBSA'' and ``MGCRB Reclass'' to accurately
reflect its reclassification to CBSA 45780. This correction
necessitated the recalculation of the FY 2022 wage index for CBSA
19124. As also discussed later in this section, because the wage
indexes are one of the inputs used to determine the out-migration
adjustment, some of the out-migration adjustments changed. Therefore,
we are making corresponding changes to the affected values.
Table 3.--Wage Index Table by CBSA--FY 2022 Final Rule. As
discussed in section II.C. of this final rule correction and correcting
amendment, we inadvertently excluded a hospital that converted to CAH
status after January 24, 2021, the cut-off date for CAH exclusion from
the FY 2022 wage index. (CMS Certification Number (CCN) 230118).
Therefore, we recalculated the wage index for rural Michigan (rural
state code 23), as reflected in Table 3, as well as the rural floor for
the State of Michigan. Also, as discussed in section II.C. of this
final rule correction and correcting amendment, CCN 360259 is
incorrectly listed as reclassified to CBSA 19124. The correct
reclassification area is to its geographic ``home'' of CBSA 45780. In
this table, we are correcting the values that changed as a result of
these corrections as well as any corresponding changes.
Table 4A.--List of Counties Eligible for the Out-Migration
Adjustment under Section 1886(d)(13) of the Act--FY 2022 Final Rule. As
discussed in section II.C. of this final rule correction and correcting
amendment, we inadvertently excluded a hospital that converted to CAH
status after January 24, 2021, the cut-off date for CAH exclusion from
the FY 2022 wage index. (CMS Certification Number (CCN) 230118). Also,
as discussed in section II.C. of this final rule correction and
correcting amendment, CCN 360259 is incorrectly listed as reclassified
to CBSA 19124. The correct reclassification area is to its geographic
``home'' of CBSA 45780. As a result, as discussed previously, we are
making changes to the FY 2022 wage indexes. Because the wage indexes
are one of the inputs used to determine the out-migration adjustment,
some of the out-migration adjustments changed. Therefore, we are making
corresponding changes to some of the out-migration adjustments listed
in Table 4A.
Table 6B.--New Procedure Codes--FY 2022. We are correcting this
table to reflect the assignment of procedure codes XW033A7
(Introduction of ciltacabtagene autoleucel into peripheral vein,
percutaneous approach, new technology group 7) and XW043A7
(Introduction of ciltacabtagene autoleucel into central vein,
percutaneous approach, new technology group 7) to Pre-MDC MS-DRG 018
(Chimeric Antigen Receptor (CAR) T-cell and Other Immunotherapies).
Table 6B inadvertently omitted Pre-MDC MS-DRG 018 in Column E (MS-DRG)
for assignment of these codes. Effective with discharges on and after
April 1, 2022, conforming changes will be reflected in the Version 39.1
ICD-10 MS-DRG Definitions Manual and ICD-10 MS-DRG Grouper and Medicare
Code Editor software.
Table 6P.--ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes--FY
2022. We are correcting Table 6P.1d associated with the final rule to
reflect three procedure codes submitted by the requestor that were
inadvertently omitted, resulting in 79 procedure codes listed instead
of 82 procedure codes as indicated in the final rule (see pages 44808
and 44809).
Table 18.--Final FY 2022 Medicare DSH Uncompensated Care Payment
Factor 3. For the FY 2022 IPPS/LTCH PPS final rule, we published a list
of hospitals that we identified to be subsection (d) hospitals and
subsection (d) Puerto Rico hospitals projected to be eligible to
receive interim uncompensated care payments for FY 2022. As stated in
the FY 2022 IPPS/LTCH PPS final rule (86 FR 45249), we allowed the
public an additional period after the issuance of the final rule to
review and submit comments on the accuracy of the list of mergers that
we identified in the final rule. Based on the comments received during
this additional period, we are updating this table to reflect the
merger information received in response to the final rule and to revise
the Factor 3 calculations for purposes of determining uncompensated
care payments for the FY 2022 IPPS/LTCH PPS final rule. We are revising
Factor 3 for all hospitals to reflect the updated merger information
received in response to the final rule. We are also revising the amount
of the total uncompensated care payment calculated for each DSH
eligible hospital. The total uncompensated care payment that a hospital
receives is used to calculate the amount of the interim uncompensated
care payments the hospital receives per discharge;
[[Page 58022]]
accordingly, we have also revised these amounts for all DSH eligible
hospitals. These corrections will be reflected in Table 18 and the
Medicare DSH Supplemental Data File. Per discharge uncompensated care
payments are included when determining total payments for purposes of
all of the budget neutrality factors and the final outlier threshold.
As a result, these corrections to uncompensated care payments required
the recalculation of all the budget neutrality factors as well as the
outlier fixed-loss cost threshold. We note that the fixed-loss cost
threshold was unchanged after these recalculations. In section IV.C. of
this final rule correction and correcting amendment, we have made
corresponding revisions to the discussion of the ``Effects of the
Changes to Medicare DSH and Uncompensated Care Payments for FY 2022''
for purposes of the Regulatory Impact Analysis in Appendix A of the FY
2022 IPPS/LTCH PPS final rule to reflect the corrections discussed
previously and to correct minor typographical errors. The files that
are available on the internet have been updated to reflect the
corrections discussed in this final rule correction and correcting
amendment.
In addition, we are correcting the inadvertent omission of the
following 32 ICD-10-PCS codes describing percutaneous cardiovascular
procedures involving one, two, three or four arteries from the GROUPER
logic for MS-DRG 246 (Percutaneous Cardiovascular Procedures with Drug-
Eluting Stent with MCC or 4+ Arteries or Stents) and MS-DRG 248
(Percutaneous Cardiovascular Procedures with Non-Drug-Eluting Stent
with MCC or 4+ Arteries or Stents).
------------------------------------------------------------------------
ICD[dash]10[dash]PCS code Description
------------------------------------------------------------------------
02703Z6....................... Dilation of coronary artery, one artery,
bifurcation, percutaneous approach.
02703ZZ....................... Dilation of coronary artery, one artery,
percutaneous approach.
02704Z6....................... Dilation of coronary artery, one artery,
bifurcation, percutaneous endoscopic
approach.
02704ZZ....................... Dilation of coronary artery, one artery,
percutaneous endoscopic approach.
02C03Z6....................... Extirpation of matter from coronary
artery, one artery, bifurcation,
percutaneous approach.
02C03ZZ....................... Extirpation of matter from coronary
artery, one artery, percutaneous
approach.
02C04Z6....................... Extirpation of matter from coronary
artery, one artery, bifurcation,
percutaneous endoscopic approach.
02C04ZZ....................... Extirpation of matter from coronary
artery, one artery, percutaneous
endoscopic approach.
02713Z6....................... Dilation of coronary artery, two
arteries, bifurcation, percutaneous
approach.
02713ZZ....................... Dilation of coronary artery, two
arteries, percutaneous approach.
02714Z6....................... Dilation of coronary artery, two
arteries, bifurcation, percutaneous
endoscopic approach.
02714ZZ....................... Dilation of coronary artery, two
arteries, percutaneous endoscopic
approach.
02C13Z6....................... Extirpation of matter from coronary
artery, two arteries, bifurcation,
percutaneous approach.
02C13ZZ....................... Extirpation of matter from coronary
artery, two arteries, percutaneous
approach.
02C14Z6....................... Extirpation of matter from coronary
artery, two arteries, bifurcation,
percutaneous endoscopic approach.
02C14ZZ....................... Extirpation of matter from coronary
artery, two arteries, percutaneous
endoscopic approach.
02723Z6....................... Dilation of coronary artery, three
arteries, bifurcation, percutaneous
approach.
02723ZZ....................... Dilation of coronary artery, three
arteries, percutaneous approach.
02724Z6....................... Dilation of coronary artery, three
arteries, bifurcation, percutaneous
endoscopic approach.
02724ZZ....................... Dilation of coronary artery, three
arteries, percutaneous endoscopic
approach.
02C23Z6....................... Extirpation of matter from coronary
artery, three arteries, bifurcation,
percutaneous approach.
02C23ZZ....................... Extirpation of matter from coronary
artery, three arteries, percutaneous
approach.
02C24Z6....................... Extirpation of matter from coronary
artery, three arteries, bifurcation,
percutaneous endoscopic approach.
02C24ZZ....................... Extirpation of matter from coronary
artery, three arteries, percutaneous
endoscopic approach.
02733Z6....................... Dilation of coronary artery, four or
more arteries, bifurcation,
percutaneous approach.
02733ZZ....................... Dilation of coronary artery, four or
more arteries, percutaneous approach.
02734Z6....................... Dilation of coronary artery, four or
more arteries, bifurcation,
percutaneous endoscopic approach.
02734ZZ....................... Dilation of coronary artery, four or
more arteries, percutaneous endoscopic
approach.
02C33Z6....................... Extirpation of matter from coronary
artery, four or more arteries,
bifurcation, percutaneous approach.
02C33ZZ....................... Extirpation of matter from coronary
artery, four or more arteries,
percutaneous approach.
02C34Z6....................... Extirpation of matter from coronary
artery, four or more arteries,
bifurcation, percutaneous endoscopic
approach.
02C34ZZ....................... Extirpation of matter from coronary
artery, four or more arteries,
percutaneous endoscopic approach.
------------------------------------------------------------------------
We have corrected the ICD-10 MS-DRG Definitions Manual Version 39
and the ICD-10 MS-DRG GROUPER and MCE Version 39 Software to correctly
reflect the inclusion of these codes in the arterial logic lists for
MS-DRGs 246 and 248 for FY 2022.
III. Waiver of Proposed Rulemaking and Delay in Effective Date
Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA),
the agency is required to publish a notice of the proposed rulemaking
in the Federal Register before the provisions of a rule take effect.
Similarly, section 1871(b)(1) of the Act requires the Secretary to
provide for notice of the proposed rulemaking in the Federal Register
and provide a period of not less than 60 days for public comment. In
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of
the Act mandate a 30-day delay in effective date after issuance or
publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA
provide for exceptions from the notice and comment and delay in
effective date APA requirements; in cases in which these exceptions
apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide
exceptions from the notice and 60-day comment period and delay in
effective date requirements of the Act as well. Section 553(b)(B) of
the APA and section 1871(b)(2)(C) of the Act authorize an agency to
dispense with normal rulemaking requirements for good cause if the
agency makes a finding that the notice and comment process are
impracticable, unnecessary, or contrary to the public interest. In
addition, both section 553(d)(3) of the APA and section
1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay
in effective date where such delay is contrary to the public interest
and an agency includes a statement of support.
We believe that this final rule correction and correcting amendment
does not constitute a rule that would be subject to the notice and
comment or
[[Page 58023]]
delayed effective date requirements. This document corrects technical
and typographical errors in the preamble, regulations text, addendum,
payment rates, tables, and appendices included or referenced in the FY
2022 IPPS/LTCH PPS final rule, but does not make substantive changes to
the policies or payment methodologies that were adopted in the final
rule. As a result, this final rule correction and correcting amendment
is intended to ensure that the information in the FY 2022 IPPS/LTCH 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 providers to receive appropriate payments in as timely a
manner as possible, and to ensure that the FY 2022 IPPS/LTCH PPS final
rule accurately reflects our policies. Furthermore, such procedures
would be unnecessary, as we are not altering our payment methodologies
or policies, but rather, we are simply implementing correctly the
methodologies and policies that we previously proposed, requested
comment on, and subsequently finalized. This final rule correction and
correcting amendment is intended solely to ensure that the FY 2022
IPPS/LTCH PPS final rule accurately reflects these payment
methodologies and policies. Therefore, 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 final rule correction and correcting amendment
because it is in the public's interest for providers to receive
appropriate payments in as timely a manner as possible, and to ensure
that the FY 2022 IPPS/LTCH PPS final rule accurately reflects our
policies.
IV. Correction of Errors
In FR Doc. 2021-16519 of August 13, 2021 (86 FR 44774), we are
making the following corrections:
A. Correction of Errors in the Preamble
1. On page 44878, second column, last paragraph, line 10, ``15
technologies'' is corrected to read ``technologies.''
2. On page 44889, lower two-thirds of the page, third column,
partial paragraph, line 10, the procedure code ``0DQ540ZZ'' is
corrected to read ``0DQ54ZZ.''
3. On page 44960, in the untitled table, last 2 lines are corrected
to read as follows:
------------------------------------------------------------------------
MDC MS-DRG MS-DRG title
------------------------------------------------------------------------
* * * * * * *
08............................. 521 Hip Replacement with
Principal Diagnosis of
Hip Fracture with MCC.
08............................. 522 Hip Replacement with
Principal Diagnosis of
Hip Fracture without
MCC.
------------------------------------------------------------------------
4. On page 45047:
a. Second column, first full paragraph, lines 21 through 24, the
sentence ``We summarize comments related to this comment solicitation
and provide our responses as well as our finalized policy in section
XXX of this final rule.'' is corrected to read ``We summarize comments
related to this comment solicitation and provide our responses in
section II.F.7. of the preamble of this final rule.''.
b. Third column, first full paragraph, line 28, the reference
``section XXX'' is corrected to read ``section II.F.8.''.
5. On page 45048, second column, second full paragraph, lines 20
through 24, the sentence ``We summarize comments related to this
comment solicitation and provide our responses as well as our finalized
policy in section XXX of this final rule.'' is corrected to read ``We
summarize comments related to this comment solicitation and provide our
responses in section II.F.7. of the preamble of this final rule.''.
6. On page 45049:
a. Second column:
(1) First full paragraph, line 12, the reference, ``section XXX of
this final rule'' is corrected to read ``section II.F.8. of the
preamble of this final rule''.
(2) Second full paragraph, lines 1 and 2, the reference, ``section
XXX of this final rule'' is corrected to read ``section II.F.7. J95.851
(Ventilator associated pneumonia) and one of the following: B96.1
(Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases
classified elsewhere), B96.20 (Unspecified Escherichia coli [E. coli]
as the cause of diseases classified elsewhere), B96.21 (Shiga toxin-
producing Escherichia coli [E. coli] [STEC] O157 as the cause of
diseases classified elsewhere), B96.22 (Other specified Shiga toxin-
producing Escherichia coli [E. coli] [STEC] as the cause of diseases
classified elsewhere), B96.23 (Unspecified Shiga toxin-producing
Escherichia coli [E. coli] [STEC] as the cause of diseases classified
elsewhere, B96.29 (Other Escherichia coli [E. coli] as the cause of
diseases classified elsewhere), B96.3 (Hemophilus influenzae [H.
influenzae] as the cause of diseases classified elsewhere, B96.5
(Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of
diseases classified elsewhere), or B96.89 (Other specified bacterial
agents as the cause of diseases classified elsewhere) for VABP.''
10. On page 45158, third column, first partial paragraph, last line
the phrase, ``technology group 5).'' is corrected to read ``technology
group 5) in combination with the following ICD-10-CM codes: Y95
(Nosocomial condition) and one of the following: J14.0 (Pneumonia due
to Hemophilus influenzae) J15.0 (Pneumonia due to Klebsiella
pneumoniae), J15.1 (Pneumonia due to Pseudomonas), J15.5 (Pneumonia due
to Escherichia coli), J15.6 (Pneumonia due to other Gram-negative
bacteria), or J15.8 (Pneumonia due to other specified bacteria) for
HABP and ICD10-PCS codes: XW033A6 (Introduction of cefiderocol
antinfective into peripheral vein, percutaneous approach, new
technology group 6) or XW043A6 (Introduction of cefiderocol anti-
infective into central vein, percutaneous approach, new technology
group 6) in combination with the following ICD-10-CM codes: J95.851
(Ventilator associated pneumonia) and one of the following: B96.1
(Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases
classified elsewhere), B96.20 (Unspecified Escherichia coli [E. coli]
as the cause of diseases classified elsewhere), B96.21 (Shiga toxin-
producing Escherichia coli [E. coli]
[[Page 58024]]
[STEC] O157 as the cause of diseases classified elsewhere), B96.22
(Other specified Shiga toxin-producing Escherichia coli [E. coli]
[STEC] as the cause of diseases classified elsewhere), B96.23
(Unspecified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as
the cause of diseases classified elsewhere, B96.29 (Other Escherichia
coli [E. coli] as the cause of diseases classified elsewhere), B96.3
(Hemophilus influenzae [H. influenzae] as the cause of diseases
classified elsewhere, B96.5 (Pseudomonas (aeruginosa)
(mallei)(pseudomallei) as the cause of diseases classified elsewhere),
or B96.89 (Other specified bacterial agents as the cause of diseases
classified elsewhere) for VABP.''
11. On page 45291, middle of the page, the table titled ``Table
V.H-11: Previously Established and Newly Updated Performance Standards
for the FY 2024 Program Year'' is corrected to read as follows:
Table V.H-11--Previously Established and Estimated Performance Standards
for the FY 2024 Program Year
------------------------------------------------------------------------
Achievement
Measure short name threshold Benchmark
------------------------------------------------------------------------
Clinical Outcomes Domain
------------------------------------------------------------------------
MORT-30-AMI ........................... 0.869247 0.887868
MORT-30-HF ............................ 0.882308 0.907773
MORT-30-PN (updated cohort) ........... 0.840281 0.872976
MORT-30-COPD .......................... 0.916491 0.934002
MORT-30-CABG .......................... 0.969499 0.980319
COMP-HIP-KNEE * ....................... 0.025396 0.018159
------------------------------------------------------------------------
[diams] As discussed in section V.H.4.b. of this final rule, we are
finalizing the updates to the FY 2024 baseline periods for measures
included in the Person and Community Engagement, Safety, and
Efficiency and Cost Reduction domains to use CY 2019. Therefore, the
performance standards displayed in this table for the Safety domain
measures were calculated using CY 2019 data.
* Lower values represent better performance.
Previously established performance standards.
12. On page 45293, top of the page, the table titled ``V.H-13
Previously Established and Estimated Performance Standards for the FY
2025 Program Year'' is corrected to read as follows:
Table V.H-13--Previously Established and Estimated Performance Standards
for the FY 2025 Program Year
------------------------------------------------------------------------
Achievement
Measure short name threshold Benchmark
------------------------------------------------------------------------
Clinical Outcomes Domain
------------------------------------------------------------------------
MORT-30-AMI ........................... 0.872624 0.889994
MORT-30-HF ............................ 0.883990 0.910344
MORT-30-PN (updated cohort) ........... 0.841475 0.874425
MORT-30-COPD .......................... 0.915127 0.932236
MORT-30-CABG .......................... 0.970100 0.979775
COMP-HIP-KNEE * ....................... 0.025332 0.017946
------------------------------------------------------------------------
* Lower values represent better performance.
Previously established performance standards.
13. On page 45294, top of page, the table titled ``V.H-14
Previously Established and Estimated Performance Standards for the FY
2026 Program Year'' is corrected to read as follows:
Table V.H-14--Previously Established and Estimated Performance Standards
for the FY 2026 Program Year
------------------------------------------------------------------------
Achievement
Measure short name threshold Benchmark
------------------------------------------------------------------------
Clinical Outcomes Domain
------------------------------------------------------------------------
MORT-30-AMI ........................... 0.874426 0.890687
MORT-30-HF ............................ 0.885949 0.912874
MORT-30-PN (updated cohort) ........... 0.843369 0.877097
MORT-30-COPD .......................... 0.914691 0.932157
MORT-30-CABG .......................... 0.970568 0.980473
COMP-HIP-KNEE * ....................... 0.024019 0.016873
------------------------------------------------------------------------
* Lower values represent better performance.
[[Page 58025]]
Previously established performance standards.
14. On page 45312, second column, first full paragraph, lines 7
through 9, the phrase ``rejection of the cost report if the submitted
IRIS GME and IME FTEs do match'' is corrected to read ``rejection of
the cost report if the submitted IRIS GME and IME FTEs do not match''.
15. On page 45386, third column, first full paragraph, line 12, the
phrase ``mellitus and who either'' is corrected to read ``mellitus,
who''.
16. On page 45400, top of the page, the table titled ``Measures for
the FY 2024 Payment Determination and Subsequent Years'', is corrected
by--
a. Correcting the title to read ``Measures for the FY 2023 Payment
Determination and Subsequent Years''.
b. Removing the heading ``Claims and Electronic Data Measures'' and
the entry ``Hybrid HWR**'' (rows 20 and 21).
c. Following the table, lines 3 through 8, removing the second
table note.
17. On page 45404, bottom of the page, after the table titled
``Measures for the FY 2025 Payment Determination and Subsequent
Years'', in the third note to the table, line 10, the parenthetical
phrase ``(July 1, 2023-June 30, 2023)'' is corrected to read ``(July 1,
2022-June 30, 2023)''.
B. Correction of Errors in the Addendum
1. On page 45532, bottom of the page, the table titled ``Summary of
FY 2022 Budget Neutrality Factors'' is corrected to read as follows:
Summary of FY 2022 Budget Neutrality Factors
------------------------------------------------------------------------
------------------------------------------------------------------------
MS[dash]DRG Reclassification and Recalibration Budget 1.000107
Neutrality Factor......................................
Wage Index Budget Neutrality Factor..................... 1.000715
Reclassification Budget Neutrality Factor............... 0.986741
*Rural Floor Budget Neutrality Factor................... 0.992868
Rural Demonstration Budget Neutrality Factor............ 0.999361
Low Wage Index Hospital Policy Budget Neutrality Factor. 0.998029
Transition Budget Neutrality Factor..................... 0.999859
------------------------------------------------------------------------
* The rural floor budget neutrality factor is applied to the national
wage indexes while the rest of the budget neutrality adjustments are
applied to the standardized amounts.
2. On page 45537, first column, first full paragraph, lines 4
through 10, the parenthetical phrase ``(estimated capital outlier
payments of $ 430,689,396 divided by (estimated capital outlier
payments of $430,689,396 plus the estimated total capital Federal
payment of $7,676,990,253)).'' is corrected to read ``(estimated
capital outlier payments of $430,698,533 divided by (estimated capital
outlier payments of $430,698,533 plus the estimated total capital
Federal payment of $7,676,964,386)).''.
3. On page 45542, third column, last paragraph, lines 23 and 24,
the figure ``$5,326,356,951'' is corrected to read ``$5,326,379,560''.
4. On page 45543:
a. Top of the page, first column, first partial paragraph:
(1) Line 1, the figure ``$100,164,666,975'' is corrected to read
``$100,165,281,272''.
(2) Line 17, the figure ``$31,108'' is corrected to read
``$31,109''.
b. Middle of the page, the untitled table is corrected to read as
follows:
------------------------------------------------------------------------
Operating
standardized Capital
amounts Federal rate *
------------------------------------------------------------------------
National................................ 0.949 0.947078
------------------------------------------------------------------------
* The adjustment factor for the capital Federal rate includes an
adjustment to the estimated percentage of FY 2022 capital outlier
payments for capital outlier reconciliation, as discussed previously
and in section III. A. 2 in the Addendum of this final rule.
5. On page 45545, the table titled ``CHANGES FROM FY 2021
STANDARDIZED AMOUNTS TO THE FY 2022 STANDARDIZED AMOUNTS'' is corrected
to read as follows:
BILLING CODE 4120-01-P
[[Page 58026]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.000
BILLING CODE 4120-01-C
6. On page 45553, second column, last paragraph, line 9, the figure
``$472.60'' is corrected to read ``$472.59''.
7. On page 45554, top of the page, in the table titled ``COMPARISON
OF FACTORS AND ADJUSTMENTS: FY 2021 CAPITAL FEDERAL RATE AND THE FY
2022 CAPITAL FEDERAL RATE'', the list entry (row 5) is corrected to
read as follows:
Comparison of Factors and Adjustments: FY 2021 Capital Federal Rate and the FY 2022 Capital Federal Rate
----------------------------------------------------------------------------------------------------------------
FY 2021 FY 2022 Change Percent change
----------------------------------------------------------------------------------------------------------------
* * * * * * *
Capital Federal Rate............................ $466.21 $472.59 1.0137 \4\ 1.37
----------------------------------------------------------------------------------------------------------------
8. On page 45570:
a. The table titled ``TABLE 1A.--NATIONAL ADJUSTED OPERATING
STANDARDIZED AMOUNTS, LABOR/NONLABOR (67.6 PERCENT LABOR SHARE/32.4
PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1)--FY 2022'' is
corrected to read as follows:
Table 1A--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (67.6 Percent Labor Share/32.4 Percent Nonlabor Share if Wage Index Is
Greater Than 1)--FY 2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is Hospital submitted quality data and Hospital did not submit quality data Hospital did not submit quality data
a meaningful EHR user (update = 2.0 is not a meaningful EHR user and is a meaningful EHR user and is not a meaningful EHR user
percent) (update = -0.025 percent) (update = 1.325 percent) (update = -0.7 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
$4,138.24 $1,983.41 $4,056.08 $1,944.03 $4,110.85 $1,970.28 $4,028.70 $1,930.91
--------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 58027]]
b. The table titled ``TABLE 1B.--NATIONAL ADJUSTED OPERATING
STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/38 PERCENT
NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)--FY 2022'' is
corrected to read as follows:
Table 1B--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share if Wage Index is Less Than
or Equal to 1)--FY 2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is Hospital submitted quality data and Hospital did not submit quality data Hospital did not submit quality data
a meaningful EHR user (update = 2.0 is not a meaningful EHR user and is a meaningful EHR user and is not a meaningful EHR user
percent) (update = -0.025 percent) (update = 1.325 percent) (update = -0.7 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
$3,795.42 $2,326.23 $3,720.07 $2,280.04 $3,770.30 $2,310.83 $3,694.96 $2,264.65
--------------------------------------------------------------------------------------------------------------------------------------------------------
9. On page 45571, the top of page:
a. The table titled ``Table 1C.--ADJUSTED OPERATING STANDARDIZED
AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL: 62
PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS
LESS THAN OR EQUAL TO 1)--FY 2022'' is corrected to read as follows:
Table 1C--Adjusted Operating Standardized Amounts for Hospitals in Puerto Rico, Labor/Nonlabor (National: 62 Percent Labor Share/38 Percent Nonlabor
Share Because Wage Index Is Less Than or Equal to 1)--FY 2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
Rates if wage index greater than 1 Hospital is a meaningful EHR Hospital is NOT a meaningful EHR
------------------------------------------------ user and wage index less than or user and wage index less than or
equal to 1 (update = 2.0) equal to 1 (update = 1.325)
Labor Nonlabor -------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ National........................ Not Applicable........ Not Applicable........ $3,795.42 $2,326.23 $3,770.30 $2,310.83
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ For FY 2022, there are no CBSAs in Puerto Rico with a national wage index greater than 1.
b. The table titled ``TABLE 1D.--CAPITAL STANDARD FEDERAL PAYMENT
RATE--FY 2022'' is corrected to read as follows:
Table 1D--Capital Standard Federal Payment Rate--FY 2022
------------------------------------------------------------------------
Rate
------------------------------------------------------------------------
National............................................... $472.59
------------------------------------------------------------------------
C. Correction of Errors in the Appendices
1. On pages 45576 through 45578, the table titled ``Table I.--
Impact Analysis of Changes to the IPPS for Operating Costs for FY
2022'' is corrected to read as follows:
BILLING CODE 4120-01-P
[[Page 58028]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.001
[[Page 58029]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.002
[[Page 58030]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.003
BILLING CODE 4120-01-C
2. On page 45579, third column, first paragraph, line 23, the
figure ``1.000712'' is corrected to read ``1.000715''.
[[Page 58031]]
3. On page 45580, lower three-fourths of the page, first column,
third full paragraph, line 6, the figure ``0.986737'' is corrected to
read ``0.986741''.
4. On pages 45582 and 45583, the table titled ``Table II.--Impact
Analysis of Changes for FY 2022 Acute Care Hospital Operating
Prospective Payment System (Payments Per Discharge)'' is corrected to
read as follows:
Table II--Impact Analysis of Changes for FY 2022 Acute Care Hospital Operating Prospective Payment System
[Payments per discharge]
----------------------------------------------------------------------------------------------------------------
Estimated Estimated
Number of average FY average FY FY 2022
hospitals 2021 payment 2022 payment changes
per discharge per discharge
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
All Hospitals................................... 3,195 13,109 13,448 2.6
By Geographic Location:
Urban hospitals............................. 2,459 13,454 13,800 2.6
Rural hospitals............................. 736 9,901 10,178 2.8
Bed Size (Urban):
0-99 beds................................... 634 10,723 11,011 2.7
100-199 beds................................ 754 11,015 11,305 2.6
200-299 beds................................ 427 12,251 12,551 2.4
300-499 beds................................ 421 13,496 13,847 2.6
500 or more beds............................ 223 16,568 16,992 2.6
Bed Size (Rural):
0-49 beds................................... 311 8,556 8,921 4.3
50-99 beds.................................. 253 9,419 9,644 2.4
100-149 beds................................ 94 9,789 10,033 2.5
150-199 beds................................ 39 10,519 10,788 2.6
200 or more beds............................ 39 11,465 11,784 2.8
Urban by Region:
New England................................. 112 14,858 15,253 2.7
Middle Atlantic............................. 304 15,432 15,814 2.5
East North Central.......................... 381 12,838 13,150 2.4
West North Central.......................... 160 13,121 13,475 2.7
South Atlantic.............................. 402 11,710 12,049 2.9
East South Central.......................... 144 11,290 11,576 2.5
West South Central.......................... 364 11,806 12,072 2.3
Mountain.................................... 172 13,698 14,054 2.6
Pacific..................................... 370 17,230 17,664 2.5
Puerto Rico................................. 50 8,491 8,637 1.7
Rural by Region:
New England................................. 19 13,990 14,463 3.4
Middle Atlantic............................. 50 9,736 9,988 2.6
East North Central.......................... 113 10,361 10,592 2.2
West North Central.......................... 89 10,638 10,932 2.8
South Atlantic.............................. 114 9,032 9,302 3
East South Central.......................... 144 8,732 8,955 2.6
West South Central.......................... 135 8,292 8,540 3
Mountain.................................... 48 12,134 12,359 1.9
Pacific..................................... 24 13,865 14,588 5.2
By Payment Classification:
Urban hospitals............................. 1,983 12,673 13,003 2.6
Rural areas................................. 1,212 13,796 14,148 2.6
Teaching Status:
Nonteaching................................. 2,031 10,677 10,963 2.7
Fewer than 100 residents.................... 907 12,388 12,694 2.5
100 or more residents....................... 257 18,938 19,437 2.6
Urban DSH:
Non-DSH..................................... 502 11,749 12,054 2.6
100 or more beds............................ 1,227 13,015 13,355 2.6
Less than 100 beds.......................... 348 9,559 9,820 2.7
Rural DSH:
SCH......................................... 265 11,906 12,203 2.5
RRC......................................... 608 14,380 14,747 2.6
100 or more beds............................ 30 12,115 12,298 1.5
Less than 100 beds.......................... 215 7,778 8,025 3.2
Urban teaching and DSH:
Both teaching and DSH....................... 679 14,116 14,483 2.6
Teaching and no DSH......................... 74 12,825 13,127 2.4
No teaching and DSH......................... 896 10,850 11,137 2.6
No teaching and no DSH...................... 334 10,824 11,110 2.6
Special Hospital Types:
[[Page 58032]]
RRC......................................... 523 14,478 14,859 2.6
SCH......................................... 305 12,053 12,356 2.5
MDH......................................... 153 9,169 9,404 2.6
SCH and RRC................................. 154 12,475 12,746 2.2
MDH and RRC................................. 27 10,622 10,853 2.2
Type of Ownership:
Voluntary................................... 1,881 13,321 13,667 2.6
Proprietary................................. 828 11,473 11,769 2.6
Government.................................. 486 14,109 14,466 2.5
Medicare Utilization as a Percent of Inpatient
Days:
0-25........................................ 643 15,158 15,535 2.5
25-50....................................... 2,110 12,926 13,268 2.6
50-65....................................... 367 10,773 11,010 2.2
Over 65..................................... 50 8,132 8,431 3.7
FY 2022 Reclassifications by the Medicare
Geographic Classification Review Board:
All Reclassified Hospitals.................. 934 13,592 13,944 2.6
Non-Reclassified Hospitals.................. 2,261 12,772 13,102 2.6
Urban Hospitals Reclassified................ 749 14,261 14,619 2.5
Urban Nonreclassified Hospitals............. 1,723 12,851 13,187 2.6
Rural Hospitals Reclassified Full Year...... 300 10,087 10,341 2.5
Rural Nonreclassified Hospitals Full Year... 423 9,610 9,929 3.3
All Section 401 Reclassified Hospitals...... 532 14,968 15,343 2.5
Other Reclassified Hospitals (Section 56 9,149 9,429 3.1
1886(d)(8)(B)).............................
----------------------------------------------------------------------------------------------------------------
5. On page 45584, bottom third of the page, third column, partial
paragraph:
a. Line 7, the figure ``$151 million'' is corrected to read ``$158
million''.
b. Line 10, the figure ``$50 million'' is corrected to read ``$57
million''.
c. Lines 15 and 16, the phrase ``for which we are approving new
technology add-on payments'' is corrected to read ``for which we are
approving or conditionally approving new technology add-on payments''.
6. On page 45585:
a. Top third of the page:
(1) In the untitled table, the third and fourth column headings and
the entries at rows 6 and 9 are corrected to read as follows:
----------------------------------------------------------------------------------------------------------------
Pathway (QIDP, LPAD,
Technology name Estimated cases FY 2022 NTAP Estimated FY 2022 or breakthrough
amount total impact device)
----------------------------------------------------------------------------------------------------------------
* * * * * * *
Fetroja (HABP/VABP)............ 379 $8,579.84 $3,251,759.36 QIDP.
* * * * * * *
Recarbrio (HABP/VABP).......... 928 9,576.51 8,887,001.28 QIDP.
* * * * * * *
----------------------------------------------------------------------------------------------------------------
(2) Following the first untitled table, second column, partial
paragraph, last line, the figure ``$498 million'' is corrected to read
``$514 million''.
b. Middle third of the page, in the untitled table, the third and
fourth column headings and the entries at rows 2 and 4 are corrected to
read as follows:
----------------------------------------------------------------------------------------------------------------
FY 2022 NTAP Estimated FY 2022
Technology name Estimated cases amount total impact
----------------------------------------------------------------------------------------------------------------
* * * * * * *
Abecma................................................. 484 $272,675.00 $131,974,700.00
[[Page 58033]]
* * * * * * *
Tecartus............................................... 15 259,350.00 3,890,250.00
* * * * * * *
----------------------------------------------------------------------------------------------------------------
7. On pages 45587 and 45588, the table titled ``Modeled
Uncompensated Care Payments for Estimated FY 2022 DSHs by Hospital
Type: Model Uncompensated Care Payments ($ in Millions)--from FY 2021
to FY 2022'' is corrected to read as follows:
BILLING CODE 4120-01-P
[[Page 58034]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.004
[[Page 58035]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.005
BILLING CODE 4120-01-C
8. On page 45588, lower half of the page, beginning with the second
column, first full paragraph, line 1 with the phrase ``Rural hospitals,
in general, are projected to experience'' and ending in the third
column last paragraph with the phrase ``15.22 percent. All'' the
paragraphs are corrected to read as follows:
``Rural hospitals, in general, are projected to experience larger
decreases in uncompensated care payments than their urban counterparts.
Overall, rural hospitals are projected to receive a 17.28 percent
decrease in uncompensated care payments, which is a greater decrease
than the overall hospital average, while urban hospitals are projected
to receive a 12.99 percent decrease in uncompensated care payments,
similar to the overall hospital average.
By bed size, smaller rural hospitals are projected to receive the
largest decreases in uncompensated care payments. Rural hospitals with
0-99 beds are projected to receive an 18.97 percent payment decrease,
and rural hospitals with 100-249 beds are projected to receive a 15.53
percent decrease. In contrast, larger rural hospitals with 250+ beds
are projected to receive a 14.16 percent payment decrease. Among urban
hospitals, the smallest urban hospitals, those with 0-99 and 100-249
beds, are projected to receive a decrease in uncompensated care
payments that is greater than the overall hospital average, at 15.49
and 15.50 percent, respectively. In contrast, the largest urban
hospitals with 250+ beds are projected to receive a 12.02 percent
decrease in uncompensated care payments, which is a smaller decrease
than the overall hospital average.
By region, rural hospitals are expected to receive larger than
average decreases in uncompensated care payments in all Regions, except
for rural hospitals in New England, which are projected to receive a
decrease of 1.27 percent in uncompensated care payments, and rural
hospitals in the East South Central Region, which are projected to
receive a smaller than average decrease of 13.01 percent. Regionally,
urban hospitals are projected to receive a more varied range of payment
changes. Urban hospitals in the New England, Middle Atlantic, and
Pacific Regions are projected to receive larger than average decreases
in uncompensated care payments. Urban hospitals in the South Atlantic,
East North Central, West North Central, West South Central, and
Mountain Regions, as well as hospitals in Puerto Rico are projected to
receive smaller than average decreases in uncompensated care payments.
Urban hospitals in the East South Central Region are projected to
receive an average decrease in uncompensated care payments.
By payment classification, although hospitals in urban areas
overall are expected to receive a 12.74 percent decrease in
uncompensated care payments, hospitals in large urban areas are
expected to see a decrease in uncompensated care payments of 13.52
percent, while hospitals in other urban areas are expected to receive a
decrease in uncompensated care payments of 11.21 percent. Rural
hospitals are projected to receive the largest decrease of 14.23
percent.
Nonteaching hospitals are projected to receive a payment decrease
of 13.4 percent, teaching hospitals with fewer than 100 residents are
projected to receive a payment decrease of 12.94 percent, and teaching
hospitals with 100+ residents have a projected payment decrease of
13.39 percent. All of these decreases closely approximate the overall
hospital average. Proprietary and voluntary hospitals are projected to
receive smaller than average decreases of 11.56 and 12.61 percent
respectively, while government hospitals are expected to receive a
larger payment decrease of 15.21 percent. All''.
9. On page 45589, first column, first partial paragraph, the phrase
``hospitals with less than 50 percent Medicare utilization are
projected to receive decreases in uncompensated care payments
consistent with the overall hospital average percent change, while
hospitals with 50-65 percent and greater than 65 percent Medicare
utilization are projected to receive larger decreases of 20.79 and
32.81 percent, respectively.'' is corrected to read as follows:
``hospitals with less than 50 percent Medicare utilization are
projected to receive decreases in uncompensated care payments
consistent with the overall hospital average percent change, while
hospitals with 50-65 percent and greater than 65 percent Medicare
utilization are projected to receive larger decreases of 20.85 and
32.86 percent, respectively.''
[[Page 58036]]
10. On page 45598, third column, last paragraph, lines 21 through
23, the sentence ``The estimated percentage increase for both rural
reclassified and nonreclassified hospitals is 1.4 percent.'' is
corrected to read ``The estimated percentage increase for rural
reclassified hospitals is 1.3 percent, while the estimated percentage
increase for rural nonreclassified hospitals is 1.4 percent.''
11. On pages 45599 and 45600, the table titled ``TABLE III.--
COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2021 PAYMENTS COMPARED TO FY
2022 PAYMENTS]'' is corrected to read as follows:
BILLING CODE 4120-01-P
[[Page 58037]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.006
[[Page 58038]]
[GRAPHIC] [TIFF OMITTED] TR20OC21.007
12. On page 45610:
a. Second column, first partial paragraph:
(1) Line 1, the figure ``$2.293'' is corrected to read ``$2.316''.
(2) Line 11, the figure ``$0.65'' is corrected to read ``$0.68''.
b. Third column, last full paragraph, last line, the figure
``$2.293'' is corrected to read ``$2.316''.
13. On page 45611, the table titled ``Table V--ACCOUNTING
STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM
FY 2021 TO FY 2022'' is corrected to read as follows:
[[Page 58039]]
------------------------------------------------------------------------
Category Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............ $2.316 billion.
From Whom to Whom......................... Federal Government to IPPS
Medicare Providers.
------------------------------------------------------------------------
List of Subjects in 42 CFR Part 413
Diseases, Health facilities, Medicare, Puerto Rico, Reporting and
recordkeeping requirements.
As noted in section II.B. of the preamble, the Centers for Medicare
& Medicaid Services is making the following correcting amendments to 42
CFR part 413:
PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED
PAYMENT RATES FOR SKILLED NURSING FACILITIES
0
1. The authority citation for part 413 continues to read as follows:
Authority: 42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a),
(i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww.
0
2. Amend Sec. 413.24 by:
0
a. In paragraph (f)(5)(i) introductory text, removing the phrase
``except as provided in paragraph (f)(5)(i)(E) of this section:'' and
adding in its place the phrase ``except as provided in paragraphs
(f)(5)(i)(A)(2)(ii) and (f)(5)(i)(E) of this section:''; and
0
b. Revising paragraph (f)(5)(i)(A).
The revision reads as follows:
Sec. 413.24 Adequate cost data and cost finding.
* * * * *
(f) * * *
(5) * * *
(i) * * *
(A) Teaching hospitals. For teaching hospitals, the Intern and
Resident Information System (IRIS) data.
(1) Data format. For cost reporting periods beginning on or after
October 1, 2021, the IRIS data must be in the new XML IRIS format.
(2) Resident counts. (i) Effective for cost reporting periods
beginning on or after October 1, 2021, the IRIS data must contain the
same total counts of direct GME FTE residents (unweighted and weighted)
and IME FTE residents as the total counts of direct GME FTE and IME FTE
residents reported in the provider's cost report.
(ii) For cost reporting periods beginning on or after October 1,
2021, and before October 1, 2022, the cost report is not rejected if
the requirement in paragraph (f)(5)(i)(A)(2)(i) of this section is not
met.
* * * * *
Karuna Seshasai,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2021-22724 Filed 10-19-21; 8:45 am]
BILLING CODE 4120-01-C
