CMS cancels two bundled payment models, changes CJR

December 5, 2017
Medicare Web

CMS announced November 30 through a final rule and interim final rule that it plans to cancel the Episode Payment Models (EPM) and Cardiac Rehabilitation (CR) Incentive Payment Model, as well as make changes to the Comprehensive Care for Joint Replacement (CJR) Model.

The EMP and CR Incentive Payment Model were scheduled to begin January 1, 2018. CMS states that the cancellation of these models allows for additional time to be dedicated to designing and testing innovations that can improve quality and care coordination across inpatient and postacute care.

The CJR Model rule allows for eligible hospitals in 33 of the 67 Metropolitan Statistical Areas (MSA) selected for participation to volunteer to be part of the model. Except for low volume and rural facilities, the model will remain mandatory for the remaining 34 MSAs selected. However, these low volume and rural hospitals in mandatory MSAs may opt to voluntarily participate. CMS will hold a one-time participation election period for these facilities from January 1, 2018, through January 31, 2018, during which time a voluntary election letter must be submitted to CMS.

CMS also aims to refine and clarify aspects of the CJR Model. CMS updated its guidance on instances when a hospital participating in the CJR Model and one that is not participating join to form a new organization that operates under the participant’s CMS Certification Number (CCN). As always, reorganization will not impact reconciliation for the participating hospital for episodes that took place prior to the effective date of the reorganization.

Episodes that occur after the effective date are subject to an updated quality-adjusted episode target price based on historical data. The rule clarifies this policy, stating that reorganized hospitals with a new CCN will be subject to reconciliation calculations based on episodes that occurred before and after the reorganization.

The interim final rule issued in conjunction with the final rule includes a comment period during which CMS is seeking comments on a policy that could allow for flexibility in determining episode costs for CJR Model participants in areas impacted by extreme circumstances, such as the major hurricanes of 2017.

For more information, see the CMS press release.

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