The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule (Proposed Rule) to scale back its mandatory bundled payment programs. Under the Proposed Rule, CMS would cancel the episode payment models (EPMs) and cardiac rehabilitation incentive payment model (CR), and it would also reduce the mandatory participation in the comprehensive care for joint replacement model (CJR). CMS stated that it believed the proposed changes are necessary because the continued mandatory participation in bundled payment models may impede CMS’s ability to engage providers in future, voluntary initiatives. CMS also stated that it anticipates testing future initiatives through applications and agreements with providers as opposed to additional rulemaking efforts.
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CMS’s Mandatory Bundled Payment Program for Lower Extremity Joint Procedures
By Robinson+Cole's Health Law Group on
In January 2016, the Centers for Medicare & Medicaid Services (CMS) finalized the somewhat controversial, mandatory Comprehensive Care for Joint Replacement Model (CJR Model), which is a bundled payment program covering certain orthopedic procedures reimbursed by Medicare. The final rule implementing the CJR Model is effective on January 15, 2016, and the first model performance period begins on April 1, 2016. With the CJR Model, CMS aims to align various providers’ financial incentives by establishing a bundled payment system for CJR Procedures conducted in acute care hospitals located in 67 metropolitan statistical areas (MSAs) across the country. Among the MSAs chosen to participate are New Haven-Milford, Connecticut; Norwich-New London, Connecticut; and New York-Newark-Jersey City, New York-New Jersey-Pennsylvania.
Continue Reading CMS’s Mandatory Bundled Payment Program for Lower Extremity Joint Procedures