This post has been archived and contains information that may be out of date.
The Centers for Medicare & Medicaid Services (CMS) finalized, without changes, its “extreme and uncontrollable” circumstances policy for hospitals participating in the Comprehensive Care for Joint Replacement (CJR) Payment Model, previously set forth in an interim final rule.
The attached final rule provides flexibility in determining episode spending for CJR hospitals located in areas impacted by a major disaster declaration for performance years three through five. The policy will become effective July 9.
CMS determined at least 22 CJR hospitals were located in areas affected by the Northern California wildfires, which include Butte, Lake, Mendocino, Napa, Nevada, Orange, Sonoma and Yuba counties. The extreme and uncontrollable policy will apply to CJR participant hospitals whose CMS certification number has a primary address located within an area that has been issued a waiver in accordance with section 1135(g) of the Social Security Act and is in a county, parish or tribal government with a major disaster declaration under the Stafford Act.
For non-fracture episodes with dates of admission to the anchor hospitalization on or within 30 days before the date that the emergency period begins, actual episode payments are capped at the target price determined for that episode under section 510.300 in the attached rule. For fracture episodes with dates of admission to the anchor hospitalization on or within 30 days before or after the date that the emergency period begins, actual episode payments are capped at the target price determined for that episode under section 510.300.
CJR participant hospitals that are subject to the policy will receive notification via the initial reconciliation reports.
