CMS releases final rule on CJR model: 5 things to know


CMS published a final rule April 29 to extend and update its Comprehensive Care for Joint Replacement model. 

Five things to know: 

1. The final rule extends the CJR model for three performance years: from October 2021 through December 2024. However, the extension only pertains to hospitals in mandatory regions of the program.

2. A definition of CJR episode now includes lower extremity joint replacement procedures performed in the hospital outpatient department. 

3. Target price calculation was changed under the rule. The basis for the target price will now be the most recent year of claims data instead of three years of claims data.

4. The model's reconciliation process was revised. Two reconciliation periods under the previous process will narrow to one. The single period will take place six months after each performance year ends. 

5. CMS will exclude rural and low-volume hospitals in the model's 34 mandatory metropolitan statistical areas and any voluntary hospitals in the 33 metropolitan statistical areas that opted in the model's third through fifth performance years.

View the full final rule here.

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