CHA News Article

CMS Issues Final Rule Cancelling Cardiac Episode Payment Models
Modifies Comprehensive Care for Joint Replacement Model participation

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule cancelling the episode payment models and Cardiac Rehabilitation Incentive Payment Model, which were set to begin Jan. 1, 2018. The final rule also implements changes to the Comprehensive Care for Joint Replacement (CJR) Model.

Despite CHA’s request to consider the entire CJR program voluntary, CMS generally adopted many of its proposed changes. Specifically, the final rule reduced the number of mandatory metropolitan statistical areas (MSAs) participating in the CJR model, with Modesto and San Francisco-Oakland-Hayward now voluntary. Los Angeles-Long Beach-Anaheim remains on the list of MSAs for mandatory participation.

Beginning Feb. 1, 2018, low-volume hospitals — defined as those with fewer than 20 CJR episodes across the three historical years of data — in the mandatory MSAs are not required to participate in the CJR model. Low-volume hospitals that choose to voluntarily participate must make a one-time participation election by Jan. 31, 2018, or be automatically dropped from the CJR model. CMS lists 28 hospitals in the Los Angeles-Long Beach-Anaheim MSA that meet this criteria.

As of Feb. 1, 2018, CMS will not require rural hospitals in the mandatory participation MSAs to participate in the CJR model. Rural hospitals choosing to voluntarily participate must make a one-time participation election by Jan. 31, 2018, or be automatically dropped from the CJR model. 

In addition to the final rule, CMS issued an interim final rule addressing the need for a policy to provide some flexibility in determination of episode costs for CJR hospitals located in areas where the Secretary of Health and Human Services has issued a waiver under section 1135 of the Social Security Act. 

CHA is reviewing the rules and will provide members with additional details in the coming weeks. More information is available in a CMS fact sheet

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