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CMS Proposes to Cancel Mandatory Episode Payment Models

The Centers for Medicare & Medicaid Services (CMS) proposes to cancel mandatory episode payment models (EPMs) for cardiac care and surgical hip/femur fracture, as well as the cardiac rehabilitation (CR) incentive payment model.

In a new proposed rule, the agency also proposes reducing the number of mandatory participants for the Comprehensive Care for Joint Replacement (CJR) model, as well as make technical refinements and clarification of certain CJR provisions. Additionally, CMS proposes reducing the number of mandatory geographic areas participating in the CJR model, from 67 to 34, and allow participants in the remaining 33 areas to participate on a voluntary basis. Specifically, there would be a one-time participation election period — Jan. 1, 2018, through Jan 31, 2018 — for hospitals located in the voluntary participation areas. Voluntary participation would be effective Feb. 1, 2018, and continue through the end of the CJR model.

The cardiac and expanded joint models’ first performance year was set to begin Jan. 1, 2018. In previous comments to CMS, America’s Essential Hospitals expressed concern about the scope and pace of these mandatory models. CMS notes that the cancellation would allow the agency “to engage providers in future voluntary efforts,” rather than large mandatory episode payment model efforts.

America’s Essential Hospitals is analyzing the proposed rule for comment and will send members a detailed Action Update. The association released a statement on CMS’ decision not to move forward with mandatory cardiac payment models. Comments on the proposed rule will be accepted for 60 days after publication in the Federal Register.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a senior policy analyst at America's Essential Hospitals.