Below are a number of resources to help member hospitals understand the regulatory framework as they move toward development and implementation of one or more alternative payment models (APMs). The information includes:
- General and program-specific resources for mandatory models such as the Comprehensive Care for Joint Replacement (CJR) Model
- Voluntary models such as the Medicare Shared Savings Program (MSSP) and the Bundled Payments for Care Improvement Initiative (BPCI)
- Models that qualify as advanced alternative payment models for physician payment incentives under the Medicare Access and CHIP Reauthorization Act of 2015
In addition, we have provided a list of helpful Centers for Medicare & Medicaid Services (CMS) website links under each of the tabs below for additional information.
As CMS continues to support new alternative payment and delivery models to reward better, more efficient, coordinated patient care, CHA encourages members to follow this page. It will be updated regularly with general and program-specific resources as they become available.
Available Resources
Recent Activity
CHA Issues Summary of Proposed Changes to Comprehensive Care for Joint Replacement Model
CMS Proposes Modifications, Extension of Joint Replacement Model
HHS Advances Payment Model to Lower Drug Costs for Patients
CHA Submits Comments on Medicare Shared Savings Program Proposed Rule
General APM
CHA Alternative Payment Model Guiding Principles
Request for Information on New Direction for CMS Innovation Center (Nov. 2017)
CJR
CJR Model 3 Year Extension and Changes to Episode Definition and Pricing Proposed Rule – comments due April 6, 2020
Final Rule – Extreme and Uncontrollable Circumstances Policy for the CJR Model – issued June 8, 2018
Final Rule – Cancellation of Episode Payment Model and Changes to CJR – issued Nov. 30, 2017
- Final Rule Summary
- List of Participating Hospitals and Status
- Template Letter – CJR Model Voluntary Participation
- OIG and CMS Joint Statement of Waivers – effective Jan. 1, 2018
- CMS Webinar on Final Rule – Dec. 13, 2017
- Proposed Rule – Cancellation of Episode Payment Model and Changes to CJR – issued Aug. 15, 2017
CJR Final Rule Member Forum Recording
- CJR Final Rule Member Forum Slide Presentation
- CMMI CJR Model Home Page
- CMS CJR Webinar Recording
- CJR Payment Methodology Examples
- CMS List of Participating California CJR Hospitals
- CJR Final Rule Summary
- CJR Final Rule
- OIG and CMS Joint Statement of Waivers – effective Jan. 1, 2018
- MLN Matters Article on SNF Three-Day Rule Waiver (Jan. 2017)
- CJR Model Frequently Asked Questions (updated March 8, 2018)
BPCI
CMS Announces Bundled Payments for Care Improvement Advanced Model
- Frequently Asked Questions (updated March 30, 2018)
- Comparison Table of Bundled Payment Models
- CMS Open Door Forum: Model Overview & Application Process
- Overview: Presentation slides and recording
- Application Process: Presentation slides and recording
- CMS BPCI Advanced Model Web Page
CMS Bundled Payments for Care Improvement Initiative Web Page (Tracks 1-4)
HLB White Paper on Bundled Payments for Care Improvement Initiative (Oct. 2011)
MSSP
Medicare Shared Savings Program “Pathways to Success” Proposed Rule
MSSP Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 Interim Final Rule
Revisions to MSSP Benchmarking Methodology Final Rule (June 2016)
Updated ACO Waivers under the MSSP Program (Oct. 2015)
Updates to MSSP Program (Track 3) Final Rule (Jun. 2015)
Medicare Shared Savings Program: Accountable Care Organizations Final Rule (Oct. 2011)
- HLB Final Rule White Paper
- SNR Denton Final Rule Summary
- CHA Final Rule First-Glance Summary
- FTC Final Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program
- IRS Final Notice 2011-20 Regarding the Participation of Tax-Exempt Organizations in ACOs