CMS Proposed Rule Significantly Alters Bundled Payment Programs

August 18, 2017

On August 16, the Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking that would cancel two mandatory payment models and significantly scale back a third. Currently slated to begin in January 2018, the two mandatory payment models proposed to be eliminated are the Cardiac Rehabilitation (CR) incentive payment model and the Episode Payment Models. The Episode Payment Models include the acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and surgical hip/femur fracture treatment episodes of care (SHFFT). 

The currently mandatory Comprehensive Care for Joint Replacement (CJR) model will create optional, rather than mandatory, participation for several of the currently participating hospitals. The CJR model was implemented in April 2016. It is proposed that up to half of the currently participating hospitals will no longer be required to participate. 

Under the proposed rule, the CJR model would continue on a mandatory basis in approximately half of the selected geographic areas (that is, 34 of the 67 selected geographic areas), with an exception for low-volume and rural hospitals, and continue on a voluntary basis in the other areas (that is, 33 of the 67 selected geographic areas). The Madison MSA (Columbia, Dane, Green, and Iowa counties) and Milwaukee-Waukesha-West Allis MSA (Milwaukee, Waukesha, Ozaukee, and Washington counties) will now be optional CJR participants.

CMS is proposing a one-time participation election period for hospitals located in the voluntary participation MSAs. The voluntary participation election period is proposed to begin January 1, 2018 and end January 31, 2018. This same voluntary election period will also apply to low-volume and rural hospitals in the mandatory participation MSAs.

Comments on the proposed rule are due to CMS October 17, and WHA will prepare comments on the proposed rule for submittal to CMS. For further information on the proposed rule, contact Laura Rose, WHA vice president for policy development,

This story originally appeared in the August 18, 2017 edition of WHA Newsletter