CMS issued an interim final rule Monday that delays implementation of cardiac care bundled payment initiatives and expansion of the existing Comprehensive Care for Joint Replacement model.
Here are six things to know about the interim final rule, which was published in the Federal Register.
1. The interim final rule delays the effective date for mandatory bundled payment programs for heart attacks and bypass surgeries from July 1, 2017, until Oct. 1, 2017. Under the cardiac bundles, acute care hospitals in certain markets will be accountable for the cost and quality of care provided to heart attack and coronary bypass patients beginning with hospitalization and extending 90 days after discharge.
2. Under the rule, the cardiac rehabilitation payment model, which will test whether a payment incentive can increase the utilization of cardiac rehabilitative services, is delayed from July 1, 2017, until Oct. 1, 2017.
3. The CJR model was slated to expand to include additional surgical treatments for hip and femur fractures beginning July 1. That expansion is delayed until Oct. 1 under the interim final rule.
4. The interim final rule further delays certain technical changes to the CJR model, such as the requirement that physicians and physician group practice collaborators give written notice to Medicare beneficiaries describing their participation in the bundled payment program. Last month, CMS delayed implementation of these changes from Feb. 18 to March 21. Now the agency has delayed implementation until May 20.
5. "The additional 3-month delay is necessary to allow time for additional review, to ensure that the agency has adequate time to undertake notice and comment rulemaking to modify the policy if modifications are warranted, and to ensure that in such a case participants have a clear understanding of the governing rules and are not required to take needless compliance steps due to the rule taking effect for a short duration before any potential modifications are effectuated," according to the interim final rule.
6. CMS said in the interim final rule that it is seeking comment on possibly further delaying the implementation of the cardiac bundles and expansion of the CJR model. The agency said it believes a delay until Jan. 1, 2018 is warranted.
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