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CMS Cancels Mandated Bundled Payment Models and Focuses on Voluntary Payment Models

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

On November 30, the Centers for Medicare & Medicaid Services (CMS) announced that it published a final rule (CMS-5524-F and IFC) officially canceling mandatory hip fracture and cardiac bundled payment models, as well as the Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model that were due to go into effect on January 1, 2018.The final rule also implements changes to the Comprehensive Care for Joint Replacement (CJR) Model. According to CMS, the changes “will offer greater flexibility and choice for hospitals in providing care to Medicare patients,” including making participation voluntary for all low-volume and rural hospitals, and are consistent with the Administration’s focus on voluntary initiatives rather than mandated bundled payment models.

In conjunction with the final rule, CMS also issued an Interim Final Rule with Comment Period in which it is establishing and seeking comment on a final policy to provide flexibility in determining episode costs for participant hospitals located in areas impacted by “extreme and uncontrollable circumstances,” such as the major hurricanes of 2017.

CMS issued a technical fact sheet summarizing the changes in the final rule and interim final rule. More information on the Comprehensive Care for Joint Replacement Model may be found on the CMS Innovation Center’s website.

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