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Joint Model Policies for Extreme Circumstances Finalized

The Centers for Medicare & Medicaid Services (CMS) finalized without changes its extreme and uncontrollable circumstances policies for hospitals participating in the Comprehensive Care for Joint Replacement (CJR) model.

Like the November 2017 interim final rule, this finalized rule provides flexibility in determining episode spending for CJR participating hospitals affected by a major disaster, such as a hurricane and wildfire, for the duration of the model. CMS recognizes that hospitals might have experienced episode cost escalation related to disasters, and policies are needed during these uncontrollable circumstances to ensure patient care is not compromised to manage costs under the CJR model.

For example, CMS notes in the rule that certain CJR participating hospitals had to close during Hurricane Irma and other CJR hospitals were called on to receive an influx of patients from affected facilities. These hospitals and CJR beneficiaries treated at them could require unplanned, and possibly extensive, health care services as a result of emergency-related injuries.

Policies in the final rule apply to CJR participating hospitals in areas designated in a major disaster declaration under the Stafford Act that also receive a Department of Health and Human Services waiver of certain Medicare requirements under section 1135 of the Social Security Act.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

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

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