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CMS Sets January 1, 2018 Effective Date for Expansion of Bundled Payment Programs

Posted in Accountable Care Organizations, Affordable Care Act, Hospitals and Institutions, Legislation and Public Policy, Life Sciences, Medical Devices, Medicare and Medicaid, Reimbursement Matters

In March, as discussed here, the Centers for Medicare & Medicaid Services (CMS) published an interim final rule that delayed the effective date of planned cardiac care bundled payment initiatives and the expansion of the Comprehensive Care for Joint Replacement (CJR) Model from July 2017 to October 2017. In a final rule dated May 19, CMS finalized the delay of the start date for the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model to January 1, 2018.

The final rule also set the effective date for changes to the existing CJR model, which align the CJR with the EPMs, to January 1, 2018. The delay is intended to give CMS adequate time to undertake notice and comment rulemaking if modifications are warranted and to give providers additional time to establish EPM care plans and networks for coordination of care. Additionally, by delaying the models to January 1, 2018, participant hospitals will have an additional six months of experience in the models before downside risk begins. CMS also cited the benefit of aligning the payment periods with the calendar year.

The new payment models and updated CJR model are intended to encourage collaboration and sharing of best practices across provider networks by creating incentives for hospitals that work with other providers to avoid readmissions and complications.

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