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CMS Delays Mandatory Bundled Payment Models

A new Centers for Medicare & Medicaid Services interim final rule further delays the implementation of a December 2016 final rule on bundled payment models for cardiac and joint care.

The interim final rule with comment period affects the Advancing Care Through Episode Payment Models, the Cardiac Rehabilitation Payment model, and changes to the Comprehensive Care for Joint Replacement (CJR) model.

The interim final rule sets an effective date of May 20 for provisions in the previous final rule, excluding changes to the CJR model. More significantly, the interim final rule pushes back the applicability date, or start date, to Oct. 1 for these models:

  • acute myocardial infarction;
  • coronary artery bypass graft;
  • surgical hip/femur fracture treatment; and
  • cardiac rehabilitation services payment.

Further, amendatory provisions to the CJR model that were set to go into effect on July 1 now will be effective and applicable on Oct. 1. These changes are primarily related to compliance issues and structural requirements of financial arrangements.

In accordance with a “regulatory freeze” set forth in a White House memorandum, CMS previously delayed until March 21 the effective date of certain technical changes to the CJR model, as well as the effective date of the cardiac care bundles and expanded CJR model. That memorandum also encouraged agencies to consider proposing a rule delaying the effective date for regulations beyond the prescribed 60-day period.

CMS now is seeking comment on the appropriateness of further delaying the start date of the cardiac and expanded CJR models until Jan. 1, 2018. Comments will be accepted for 30 days after the rule is filed in the Federal Register on March 21.

Contact 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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