Comprehensive Care for Joint Replacement Model Three-Year Extension Final Rule Summary

On May 03, 2021, CMS published in the Federal Register a final rule that would extend the Comprehensive Care for Joint Replacement (CJR) model for an additional 3 performance years, among other policy and technical changes (83 FR 23496-23576). The CJR model, which began in April 2016, is an episode bundled payment model that is designed to support higher quality and more cost-effective care for beneficiaries undergoing hip and knee replacements, or other lower extremity joint replacements. The final rule provides a three-year extension to the CJR model, through December 31, 2024, for certain participant hospitals. This extension would apply to participant hospitals in the 34 metropolitan statistical areas where participation is mandatory, excluding hospitals that are “low- volume”, designated as “rural”, or that had voluntarily elected to participate in performance years (PYs) 3 through 5. CMS also finalizes key changes to the episode of care definition, the target price calculation, the reconciliation process, the beneficiary notice requirements, and the appeals process that would apply beginning in PY 6.