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The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule that would cancel the episode payment models (EPMs) and the cardiac rehabilitation incentive payment model, scheduled to begin Jan. 1, 2018. The proposed rule would also reduce the number of mandatory metropolitan statistical areas (MSAs) participating in the Comprehensive Care for Joint Replacement (CJR) model, including two in California: Modesto and San Francisco-Oakland-Hayward. Los Angeles-Long Beach-Anaheim remains on CMS’ list of MSAs for mandatory participation.
In addition, CMS proposes to exempt rural hospitals and low-volume hospitals located in the mandatory participation MSAs from required participation in the CJR model beginning in February 2018, and allow them instead to make a one-time voluntary participation election.
CMS defines low-volume as hospitals with fewer than 20 CJR episodes across the three historical years of data, and lists 28 hospitals in the Los Angeles-Long Beach-Anaheim MSA that meet the criteria. Under the proposed rule, hospitals in the 33 voluntary MSAs may also elect to participate during the one-time participation election period of Jan. 1-31, 2018.
CMS makes additional technical changes to the CJR model. CHA is reviewing the proposed rule and will provide members with additional detail in the coming weeks. A fact sheet is attached. Comments on the proposed rule are due Oct. 16.
