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

• Published date: 20 October 2021
• Citation: 86 FR 58019
• Record Number: 2021-22724
• Section: Rules and Regulations
• Court: Centers For Medicare & Medicaid Services

58019

Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations

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, julia.venanzi@

cms.hhs.gov, 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 Aprevo

TM

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.

On page 45158, we inadvertently

omitted the ICD–10–CM diagnosis codes

used to identify cases involving the use

of RECARBRIO

TM

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 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

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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.

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

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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 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

Aprevo

TM

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/

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

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;

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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

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-10-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

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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

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]

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[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:

T

ABLE

V.H–11—P

REVIOUSLY

E

STABLISHED AND

E

STIMATED

P

ERFORMANCE

S

TANDARDS FOR THE

FY 2024 P

ROGRAM

Y

EAR

Measure short name Achievement

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

♦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:

T

ABLE

V.H–13—P

REVIOUSLY

E

STABLISHED AND

E

STIMATED

P

ERFORMANCE

S

TANDARDS FOR THE

FY 2025 P

ROGRAM

Y

EAR

Measure short name Achievement

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:

T

ABLE

V.H–14—P

REVIOUSLY

E

STABLISHED AND

E

STIMATED

P

ERFORMANCE

S

TANDARDS FOR THE

FY 2026 P

ROGRAM

Y

EAR

Measure short name Achievement

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.

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#

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:

S

UMMARY OF

FY 2022 B

UDGET

N

EUTRALITY

F

ACTORS

MS-DRG Reclassification and Recalibration Budget Neutrality Factor .............................................................................................. 1.000107

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

amounts

Capital

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

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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:

C

OMPARISON OF

F

ACTORS AND

A

DJUSTMENTS

: FY 2021 C

APITAL

F

EDERAL

R

ATE AND THE

FY 2022 C

APITAL

F

EDERAL

R

ATE

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:

T

ABLE

1A—N

ATIONAL

A

DJUSTED

O

PERATING

S

TANDARDIZED

A

MOUNTS

, L

ABOR

/N

ONLABOR

(67.6 P

ERCENT

L

ABOR

S

HARE

/32.4 P

ERCENT

N

ONLABOR

S

HARE IF

W

AGE

I

NDEX

I

S

G

REATER

T

HAN

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

$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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CHANGES FROM

FY

2021 STANDARDIZED AMOUNTS TO THE

FY

2022

STANDARDIZED AMOUNTS

Hospital

Submitted

Quality

Hospital

Submitted

Quality

Hospital

Did

NOT

Submit

Hospital

Did

NOT

Submit

Data

and

is

a

Meaningful

Data

and

is

NOT

a

Quality

Data

and

is

a

Quality

Data

and

is

NOT

a

EHR

User

Meaninaful

EHR

User

Meaninaful

EHR

User

Meaninaful

EHR

User

FY

2022

Base

Rate

after

removing:

If

Wage

Index

is

Greater

If

Wage

Index

is

Greater

Than

If

Wage

Index

is

Greater

Than

If

Wage

Index

is

Greater

Than

1.

FY

2021

Geographic

Reclassification

Than

1.0000:

1.0000:

1.0000: 1.0000:

Budget

Neutrality

(0.986616)

Labor

(67.6%):

$4,319.35

Labor(67.6%):

$4,319.35

Labor(67.6%):

$4,319.35

Labor

(67.6%):

$4,319.35

2.

FY

2021

Operating

Outlier

Offset

(0.949)

Nonlabor

(32.4%):

$

2,070.22

Nonlabor

(32.4%):

$2,070.22

Nonlabor

(32.4%):

$2,070.22

Nonlabor

(32.4%):

$2,070.22

3.

FY

2021

Rural

Demonstration

Budget

If

Wage

Index

is

less

Than

or

If

Wage

Index

is

less

Than

or

If

Wage

Index

is

less

Than

or

If

Wage

Index

is

less

Than

or

Neutrality

Factor

(0.999626)

Equal

to

1.0000:

Equal

to

1.0000:

Equal

to

1.0000:

Equal

to

1.0000:

4.

FY

2021

Lowest

Quartile

Budget

Neutrality

Labor

(62%):

$3,961.53

Labor

(62%):

$

3,961.53

Labor

(62%):

$

3,961.53

Labor

(62%):

$

3,961.53

Factor

(0.99797)

Nonlabor

(38%):

$

2,428.04

Nonlabor

(38%):

$

2,428.04

Nonlabor

(38%):

$

2,428.04

Nonlabor

(38%):

$

2,428.04

5.

FY

2021

Transition

Budget

Neutrality

Factor

(0.998851)

FY

2022

Uodate

Factor

1.02

0.99975

1.01325

0.993

FY

2022

MS-DRG

Reclassification

and

Recalibration

Budaet

Neutrality

Factor

1.000107

1.000107 1.000107

1.000107

FY

2022

Wage

Index

Budget

Neutrality

Factor

1.000715

1.000715 1.000715

1.000715

FY

2022

Reclassification

Budget

Neutrality

Factor

0.986741 0.986741

0.986741 0.986741

FY

2022

Rural

Demonstration

Budget

Neutralitv

Factor

0.999361 0.999361 0.999361

0.999361

FY

2022

Lowest

Quartile

Budget

Neutrality

Factor

0.998029

0.998029

0.998029

0.998029

FY

2022

Transition

Budqet

Neutrality

Factor

0.999859 0.999859 0.999859 0.999859

FY

2022

Ooeratina

Outlier

Factor

0.949

0.949

0.949 0.949

Adjustment

for

FY

2022

Required

under

Section

414

of

Pub.

L.114-10

(MACRA)

1.005 1.005

1.005

1.005

National

Standardized

Amount

for

FY

2022

if

Wage

Index

is

Greater

Than

1.0000;

Labor/Non-Labor

Share

Percentage

Labor:

$4,138.24

Labor:

$4,056.08

Labor:

$4,110.85

Labor:

$4,028.70

167

.6/32.41

Nonlabor

$1,983.41

Nonlabor:

$1,944.03

Nonlabor:

$1,970.28

Nonlabor:

$1,930.91

National

Standardized

Amount

for

FY

2022

if

Wage

Index

is

Less

Than

or

Equal

to

1.0000;

Labor/Non-Labor

Share

Percentage

Labor:

$3,795.42

Labor:

$3,720.07

Labor:

$3,770.30

Labor:

$3,694.96

162/381

Nonlabor:

$2

326.23

Non

labor:

$2

280.04

Non

labor:

$2

310.83

Nonlabor:

$2

264.65

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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:

T

ABLE

1B—N

ATIONAL

A

DJUSTED

O

PERATING

S

TANDARDIZED

A

MOUNTS

, L

ABOR

/N

ONLABOR

(62 P

ERCENT

L

ABOR

S

HARE

/

38 P

ERCENT

N

ONLABOR

S

HARE IF

W

AGE

I

NDEX IS

L

ESS

T

HAN OR

E

QUAL 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:

T

ABLE

1C—A

DJUSTED

O

PERATING

S

TANDARDIZED

A

MOUNTS FOR

H

OSPITALS IN

P

UERTO

R

ICO

, L

ABOR

/N

ONLABOR

(N

A

-

TIONAL

: 62 P

ERCENT

L

ABOR

S

HARE

/38 P

ERCENT

N

ONLABOR

S

HARE

B

ECAUSE

W

AGE

I

NDEX

I

S

L

ESS

T

HAN OR

E

QUAL TO

1)—FY 2022

Rates if wage index greater than 1 Hospital is a meaningful EHR

user and wage index less than

or equal to 1

(update = 2.0)

Hospital is NOT a meaningful

EHR user and wage index less

than or 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:

T

ABLE

1D—C

APITAL

S

TANDARD

F

EDERAL

P

AYMENT

R

ATE

—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

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58028

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Table

1.-Impact

Analysis

of

Changes to the IPPS for Operating Costs for FY 2022

FY2022

Weights

and

Rural

DRG

FY 2022

Floor

with

Application

Hospital

Changes

with

Wage

Data

Application

of

the

Rate

Application

with

of

National

Frontier

Update

and

of

Application

Rural

Imputed

State

Wage

Adjustment

Recalibration

ofWage

FY2022

Floor Floor

Index

and

AIIFY

Number

under

Budget

Budget

MGCRB Budget Wage Outmigration 2022

of

MACRA Neutrality Neutrality Reclassifications Neutrality Index Adjustment Changes

Hospitals'

(1)2

(2) 3 (3) 4 (4) s (5)6 (6) 7 (7)" (8)9

All Hospitals 3,195 2.5 0.0 0.0 0.0 0.0 0.2 0.1 2.6

Bv

Geo!!raohic Location:

Urban hosoitals 2,459 2.5 0.0 0.0 -0.1 0.0 0.2 0.1 2.6

Rural hospitals 736 2.2 0.1 0.2

1.3

-0.2 0.0 0.1 2.8

Bed Size (Urban):

0-99 beds 634 2.4 0.0 0.1 -0.6 0.1 0.2 0.3 2.7

100-199 beds 754 2.5 0.0 0.0 -0.2 0.2 0.2 0.2 2.6

200-299 beds 427 2.5 0.0 0.1 0.2 0.0 0.2 0.1 2.4

300-499 beds 421 2.5 0.0 0.0 0.1 0.0 0.1 0.1 2.6

500

or

more beds 223 2.5 0.0 -0.1 -0.3 0.0 0.2 0.0 2.6

Bed Size (Rural):

0-49 beds 311 2.1 0.1 0.3 0.7 -0.1 0.0 0.2 4.3

50-99 beds 253 2.1 0.1 0.2 0.8 -0.1 0.0 0.2 2.4

100-149 beds 94 2.1 0.1 0.2

1.3

-0.2 0.0 0.0 2.5

150-199 beds 39 2.3 0.0 0.2 1.6 -0.2 0.0 0.1 2.6

200

or

more beds 39 2.3 0.0 0.3 2.0 -0.3 0.0 0.0 2.8

Urban by Re!!ion:

New

England 112 2.5 0.0 -1.0 0.8 3.7 0.6 0.1 2.7

Middle Atlantic 304 2.5 0.0 -0.2 0.3 -0.4 0.5 0.2 2.5

East North Central 381 2.5 0.0 -0.2 -0.2 -0.4 0.0 0.0 2.4

West North Central 160 2.4 -0.1 0.2 -0.6 -0.3 0.0 0.6 2.7

South Atlantic 402 2.5 0.0 0.3 -0.5 -0.3 0.2 0.0 2.9

East South Central 144 2.5 0.0 0.1 -0.3 -0.3 0.0 0.0 2.5

West South Central 364 2.5 0.0 -0.3 -0.5 -0.3 0.0 0.0 2.3

Mountain 172 2.4 0.0 0.2 0.1 -0.1 0.0 0.2 2.6

Pacific 370 2.4 -0.1 0.5 0.2 0.4 0.0

0.1

2.5

Puerto Rico 50 2.5 -0.5 -0.3 -1.0 0.2 0.0 0.1 1.7

Rural by Re2ion:

New England

19

2.3 0.0 -0.4

1.3

-0.3 0.2 0.0 3.4

Middle Atlantic 50 2.2 0.1 0.3 1.0 -0.2 0.0 0.0 2.6

East North Central 113 2.2 0.1 0.1 0.9 -0.1 0.0 0.0 2.2

West North Central 89 2.1 0.0 0.1 0.3 -0.1 0.0 0.2 2.8

South Atlantic 114 2.2 0.1

1.1

1.6 -0.2 0.0 0.0 3.0

East South Central 144 2.3 0.1 -0.1 1.8 -0.3 0.0 0.1 2.6

West South Central 135 2.2 0.1 0.0 2.8 -0.3 0.0 0.0 3.0

58029

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FY2022

Weights and Rural

DRG

FY2022

Floor with Application

Hospital Changes with Wage Data Application

of

the

Rate Application with

of

National Frontier

Update and

of

Application Rural Imputed State Wage

Adjustment Recalibration

ofWage

FY2022

Floor Floor Index and AIIFY

Number under Budget Budget MGCRB Budget Wage Outmigration 2022

of

MACRA Neutrality Neutrality Reclassifications Neutrality Index Adjustment Changes

Hospitals1 (1)2 (2)3

(3)

4

(4)

s

(5)6

(6)

7

(7)"

(8)9

Mountain 48 1.9 0.0 0.6 -0.1 -0.1 0.0 0.8 1.9

Pacific 24 2.1 0.0 -0.1

1.1

-0.1 0.0 0.0 5.2

By Payment Classification:

Urban hosoitals 1,983 2.5 0.0 0.0 -0.6 0.2 0.2

0.1

2.6

Rural areas 1,212 2.4 0.0 0.0 0.9 -0.3

0.1 0.1

2.6

Teaching Status:

Nonteaching 2,031 2.4 0.0 0.2

0.1 0.1 0.1 0.1

2.7

Fewer than 100 residents 907 2.5 0.0 0.0

0.1

-0.1 0.2 0.2 2.5

100

or

more residents 257 2.4 0.0 -0.1 -0.2 0.0 0.2 0.0 2.6

UrbanDSH:

Non-DSH 502 2.5 0.0 0.0 -0.6 0.0 0.3 0.2 2.6

100

or

more beds 1,227 2.5 0.0 0.0 -0.6 0.2 0.2

0.1

2.6

Less than 100 beds 348 2.5 0.0

0.1

-0.5 0.2

0.1

0.2 2.7

RuralDSH:

SCH 265 2.0 0.0 0.1 0.2 0.0 0.0

0.1

2.5

RRC 608 2.4 0.0 0.0 1.0 -0.3

0.1 0.1

2.6

100

or

more beds

30

2.4

0.1

-0.1

0.1

-0.4 0.0 0.0 1.5

Less than 100 beds 215 2.3

0.1

0.3 1.0 -0.3 0.0 0.2 3.2

Urban teaching and DSH:

Both teaching and DSH 679 2.5 0.0 -0.1 -0.6

0.1 0.3 0.1

2.6

Teaching and no DSH 74 2.5 0.0 -0.1 -0.9 0.6 0.4 0.2 2.4

No teaching and DSH 896 2.5 0.0 0.2 -0.5 0.4

0.1 0.1

2.6

No teaching and

no

DSH 334 2.5 0.0 0.1 -0.6 -0.2

0.3

0.3 2.6

Special Hospital Types:

RRC 523 2.5 0.0 0.0 1.0 -0.4

0.1 0.1

2.6

SCH 305 2.0 0.0 0.1

0.1

0.0 0.0 0.0 2.5

MDH 153

2.1

0.1 0.0 0.0 -0.2

0.1 0.1

2.6

SCHandRRC

154

2.1

0.0 0.1 0.5 -0.1 0.0 0.0 2.2

MDHandRRC

27 2.2 0.0 0.0 0.7 -0.2

0.1

0.0 2.2

Tvoe

of

Ownership:

Voluntarv 1,881 2.5 0.0 -0.1

0.1

0.0 0.2

0.1

2.6

Proprietarv 828 2.5 0.0

0.1

-0.1

0.1 0.1 0.1

2.6

Government 486 2.4 0.0 0.2 -0.3 -0.1 0.0 0.0 2.5

Medicare Utilization as a Percent

oflnpatient

Davs:

0-25 643 2.5 0.0 0.1 -0.6 -0.2 0.0 0.0 2.5

25-50 2,110 2.5 0.0 0.0

0.1

0.0 0.2

0.1

2.6

50-65 367 2.4 0.0 -0.1 0.2

0.3

0.3 0.2 2.2

Over65

50 2.3 0.1 0.3 -0.7 -0.3 0.3

0.1

3.7

58030

Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations

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’’.

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FY2022

Weights

and

Rural

DRG

FY2022

Floor

with

Application

Hospital

Changes

with

Wage

Data

Application

of

the

Rate

Application

with

of

National

Frontier

Update

and

of

Application

Rural

Imputed

State

Wage

Adjustment

Recalibration

ofWage

FY2022

Floor Floor

Index

and

AIIFY

Number

under

Budget

Budget

MGCRB

Budget

Wage

Outmigration

2022

of

MACRA Neutrality Neutrality Reclassifications Neutrality Index Adjustment Changes

Hospitals' (1)2 (2) 3

(3)

4 (4) 5

(5)6

(6) 7

(7)"

(8)9

FY 2022 Reclassifications:

All

Reclassified Hospitals 934 2.4 0.0 0.0 1.2 -0.3 0.1 0.1

Non-Reclassified Hosoitals 2,261 2.5 0.0 0.0 -0.9 0.2 0.2 0.2

Urban

Hospitals Reclassified 749 2.4 0.0 0.0

I.I

-0.3 0.1 0.1

Urban

Non-Reclassified Hospitals 1,723 2.5 0.0 0.0

-I.I

0.3 0.3 0.1

Rural Hospitals Reclassified Full

Year

300 2.2 0.1 0.2 2.0 -0.2 0.0 0.0

Rural Non-Reclassified HosPitals Full

Year

423 2.2 0.1 0.2 0.0 -0.2 0.0 0.2

All

Section 401 Reclassified Hospitals 532 2.4 0.0 0.0 0.8 -0.3 0.1 0.1

Other

Reclassified Hospitals (Section 1886(d)(8)(B)) 56 2.3 0.1 0.0 2.4 -0.3 0.2 0.0

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.

2.6

2.6

2.5

2.6

2.5

3.3

2.5

3.1

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.

58031

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

System (Payments Per Discharge)’’ is

corrected to read as follows:

T

ABLE

II—I

MPACT

A

NALYSIS OF

C

HANGES FOR

FY 2022 A

CUTE

C

ARE

H

OSPITAL

O

PERATING

P

ROSPECTIVE

P

AYMENT

S

YSTEM

[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 ..................................................................................................... 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:

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58032

Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations

T

ABLE

II—I

MPACT

A

NALYSIS OF

C

HANGES FOR

FY 2022 A

CUTE

C

ARE

H

OSPITAL

O

PERATING

P

ROSPECTIVE

P

AYMENT

S

YSTEM

—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 .......................................................................................................... 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 Re-

view 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 1886(d)(8)(B)) .............................. 56 9,149 9,429 3.1

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:

Technology name Estimated cases FY 2022 NTAP

amount Estimated FY

2022 total impact

Pathway

(QIDP, LPAD, or

breakthrough

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:

Technology name Estimated cases FY 2022 NTAP

amount Estimated FY

2022 total impact

*******

Abecma ...................................................................................................................... 484 $272,675.00 $131,974,700.00

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58033

Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations

Technology name Estimated cases FY 2022 NTAP

amount Estimated FY

2022 total impact

*******

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

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Modeled Uncompensated Care Payments for Estimated FY 2022 DSHs by Hospital Type: Model

Uncompensated Care Payments($ in Millions)* -from FY 2021 to

FY

2022

FY

2021 Final FY 2022 Final

Rule Estimated Rule Estimated

Number

of

Uncompensated Uncompensated Dollar Difference:

Estimated Care Payments Care Payments

FY

2021-FY

2022 Percent

DSHs ($ in millions) ($ in millions) ($ in millions) Change**

(1)

(2)

(3)

(4)

(5)

Total 2,365 8,290 7,192 -1098 -13.24%

By

Geographic Location

Urban Hospitals 1,900 7,803 6,789 -1014 -12.99

Large Urban Areas 989 4,829 4,146 -683 -14.15

Other Urban Areas 911 2,974 2,643 -331 -11.12

Rural Hospitals 465 487 403 -84 -17.28

Bed Size (Urban)

0 to 99 Beds 325 290 245 -45 -15.49

100 to 249 Beds 818 1,898 1,603 -294 -15.50

250+ Beds 757 5,615 4,940 -675 -12.02

Bed Size (Rural)

0 to 99 Beds 352 269 218

-51

-18.97

100 to 249 Beds 100 166

141

-26 -15.53

250+ Beds

13

52 45 -7 -14.16

Urban bv Re2ion

New England 92 227 186 -40 -17.79

Middle Atlantic 230 983 819 -163 -16.62

South Atlantic 313 864 800 -64 -7.44

East North Central

98

405 354

-51

-12.58

East South Central 312 2,027 1,759 -268 -13.2

West North Central 126 498 439 -59 -11.92

West South Central 241 1,637 1,434 -204 -12.44

Mountain 132 333 299 -34 -10.32

Pacific 315 723 607 -116 -15.99

Puerto Rico

41

107

93

-14 -13.01

Rural by Region

New England 8

15 15

0 -1.27

Middle Atlantic

21

15

12

-3

-17.92

South Atlantic

65

58

43

-15 -25.28

East North Central 28

31

23

-8 -25.87

East South Central

83

135

117 -18 -13.01

West North Central 124 102

85

-18 -17.22

West South Central 107 105 88 -17 -15.92

Mountain 24

19 14

-5 -25.92

Pacific 5 7 5 -2 -25.68

Bv

Pavment Classification

Urban Hospitals 1,506 5,470 4,773 -697 -12.74

Large Urban Areas 850 3,614 3,125 -489 -13.52

Other Urban Areas 656 1,855 1,648 -208 -11.21

Rural Hospitals 859 2,820 2,419 -401 -14.23

Teaching Status

N onteaching 1,370 2,444 2,116 -328 -13.4

Fewer than 100 residents 742 2,865 2,494 -371 -12.94

100 or more residents 253 2,980 2,581 -399 -13.39

Tvpe

of

Ownership

Voluntarv 1,422 4,556 3,981 -574 -12.61

Proprietarv 575 1,217 1,076 -141 -11.56

58035

Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations

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.’’

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Modeled Uncompensated Care Payments for Estimated FY 2022 DSHs by Hospital Type: Model

Uncompensated Care Payments($ in Millions)* -from FY 2021 to FY 2022

FY 2021 Final FY 2022 Final

Rule Estimated Rule Estimated

Number

of

Uncompensated Uncompensated Dollar Difference:

Estimated Care Payments Care Payments FY 2021 -FY 2022 Percent

DSHs ($ in millions) ($ in millions) ($ in millions) Change**

(1) (2) (3) (4) (5)

Government 368 2,517 2,134 -383

Medicare Utilization Percent***

0 to 25 554 3,388 2,940 -448

25 to 50 1,602 4,707 4,098 -609

50 to

65

187 189 150 -39

Greater than

65

22 6 4 -2

Source: Dobson I

Davanzo

analysis

of2013

and 2018 Hospital Cost Reports.

*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.

-15.21

-13.22

-12.94

-20.85

-32.86

58036

Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations

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

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TABLE

111.--COMPARISON

OF

TOTAL

PAYMENTS

PER

CASE

[FY 2021

PAYMENTS

COMPARED

TO

FY 2022

PAYMENTS]

Average Average

Number

of

FY 2021

FY2022

Change

Hospitals Payments/ Payments/

Case Case

All hospitals 3,195

981

990 0.9

By

Geographic Location:

Urban Hospitals 2,459 1,014 1,023 0.9

Rural areas 736 673 683

1.5

Bed Size (Urban)

0-99 beds 634

803

813 1.2

100-199 beds 754 860

871

1.3

200-299 beds 427 939 949

1.1

300-499 beds 421 1,020 1,029 0.9

500 or more beds 223 1,215 1,221 0.5

Bed Size (Rural)

0-49 beds 311 568 577 1.6

50-99 beds 253 626 634

1.3

100-149 beds 94 666 675 1.4

150-199 beds 39 737 750 1.8

200 or more beds 39 797 810 1.6

By

Region:

Urban by Region

New England 112 1,104 1,121

1.5

Middle Atlantic 304 1,129 1,134 0.4

South Atlantic 402 889 902

1.5

East North Central 381 966 975 0.9

East South Central 144

863

869 0.7

West North Central 160 989 994 0.5

West South Central 364 927 929 0.2

Mountain 172 1,023 1,032 0.9

Pacific 370 1,304 1,314 0.8

Rural by Region

New England

19

937 953 1.7

Middle Atlantic 50 651 662 1.7

South Atlantic 114 623 637 2.2

East North Central

113

681 687 0.9

East South Central 144 630 636 1.0

West North Central 89 701 709

1.1

West South Central 135 602 616 2.3

Mountain 48 765 773 1.0

Pacific 24 869 876 0.8

By

Payment Classification:

Urban hospitals 1,983 982 995

1.3

Rural areas 1,212 980 981

0.1

Teaching Status:

Non-teaching 2,031 817 828

1.3

Fewer than 100 Residents 907

941

949 0.9

58038

Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations

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:

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TABLE

111.--COMPARISON

OF

TOTAL

PAYMENTS

PER

CASE

rFY

2021

PAYMENTS

COMPARED

To

FY

2022

PAYMENTS

Average Average

Number

of

FY 2021

FY2022

Change

Hospitals Payments/ Payments/

Case Case

100 or more Residents 257 1,358 1,365 0.5

UrbanDSH:

Non-DSH 502 904 915 1.2

100 or more beds 1,227 1,008 1,022 1.4

Less than 100 beds 348 728 737 1.2

OClural

DSH:

Sole Community (SCH/EACH) 265 751 750 -0.1

Referral Center (RRC/EACH) 608 1,030 1,031

0.1

100 or more beds 30 895 875 -2.2

Less than 100 beds 215 559 567 1.4

Urban teaching and DSH:

Both teaching and DSH 679 1,075 1,090 1.4

Teaching and no DSH 74

981

993 1.2

No teaching and DSH 896 866 878 1.4

No teaching and no DSH 334 859 870

1.3

Special Hospital Types:

Non special status hospitals 152 781 775 -0.8

RRC/EACH 523 1,061 1,063 0.2

SCH/EACH 305 758 758 0.0

Medicare-dependent hospitals (MDH)

153

610 615 0.8

SCH, RRC and EACH 154 807 815 1.0

MDH, RRC and EACH 27 687 694 1.0

Type

of

Ownership:

Voluntarv 1,881 993 1,002 0.9

Proprietarv 828 896 905 1.0

Government 486 1,031 1,035 0.4

Medicare Utilization as a Percent

of

Inpatient Days:

0-25 643 1,119 1,125 0.5

25-50 2,110 972 981 0.9

50-65 367 797 804 0.9

Over65

50 586 596 1.7

~022 Reclassifications by the Medicare

Classification Review Board:

All Reclassified Hospitals 934 987 993 0.6

All Nomeclassified Hospitals 2,261 977 988

1.1

Urban Hospitals Reclassified 749 1,039 1,042 0.3

Urban Nomeclassified Hospitals 1,723 995 1,008

1.3

Rural Hospitals Reclassified Full Year 300 695 704

1.3

Rural Nomeclassified Hospitals Full Year 423

641

650 1.4

All Section 401 Reclassified Hospitals 532 1,073 1,072 -0.1

Other Reclassified Hospitals (Section 1886(d)(8)(B)) 56 662 672 1.5

58039

Federal Register / Vol. 86, No. 200 / Wednesday, October 20, 2021 / Rules and Regulations

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

■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.

■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:

§ 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

FEDERAL COMMUNICATIONS

COMMISSION

47 CFR Part 64

[WC Docket No. 17–97; FCC 20–136; FRS

52215]

Call Authentication Trust Anchor

AGENCY

: Federal Communications

Commission.

ACTION

: Final rule; announcement of

effective date.

SUMMARY

: 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.

DATES

: 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

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.

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