On February 17, 2017, the U.S. Department of Health & Human Services (HHS) announced that it had delayed the effective date of provisions of a Centers for Medicare & Medicaid Services (CMS) Final Rule that were scheduled to take effect February 18, 2017. The Final Rule – titled “Advancing Care Coordination through Episode Payment Models” – was issued January 3, 2017 (see our previous analysis here) and in pertinent part implements:
- Three new Medicare episode payment models (EPMs) surrounding 90-day episodes of care arising from (a) an acute myocardial infarction (AMI), (b) a coronary artery bypass graft (CABG), or (c) a surgical hip/femur fracture treatment (SHFFT);
- An incentive payment model to spur increased utilization of cardiac rehabilitation and intensive cardiac rehabilitation for Medicare beneficiaries; and
- Modifications to the Comprehensive Care for Joint Replacement model (CJR Model), an ongoing CMS payment model involving hip and knee replacements that started on April 1, 2016.
Under the Final Rule, participation in the AMI and CABG EPMs is mandatory for hospitals located in 98 randomly-selected metropolitan statistical areas (MSAs), and participation in the SHFFT EPM is mandatory for hospitals in the 67 MSAs that currently participate in the CJR Model.
Provisions of the final rule that were initially scheduled to take effect February 18, 2017 are now scheduled to take effect March 21, 2017. Provisions of the final rule that were scheduled to take effect July 1, 2017 – comprising the CJR model revisions – remain scheduled to take effect on that date.
HHS made this delay in accordance with the new administration’s “Regulatory Freeze Pending Review” memorandum issued January 20, 2017 that instructed executive agencies to temporarily delay – for a period of 60 days – any regulations that had been published but had not yet taken effect at that time. It remains to be seen whether the new administration will allow the Final Rule to be implemented in its current form.