CMS postpones expansion, implementation of bundled payment programs

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Four new bundled payment models, as well as changes to the Comprehensive Care for Joint Replacement program, were delayed in a rule posted on Monday.
Four new bundled payment models, as well as changes to the Comprehensive Care for Joint Replacement program, were delayed in a rule posted on Monday.

The Centers for Medicare & Medicaid Services is pushing back the implementation date for its recent rule creating a bundled payment program for cardiac care, as well as changes to the Comprehensive Care for Joint Replacement program. Further delays also are being considered.

The cardiac care models, announced late last year, would create bundles for patients who receive cardiac rehabilitation, suffer heart attacks or undergo heart surgery. The models were slated to begin demonstrations on July 1, 2017, and run through 2021. A fourth bundle was also finalized, focusing on patients who undergo non-replacement surgery following a hip fracture.

The cardiac final rule also included a provision to make updates to the CJR model, including “refinements” of the bundle's skilled nursing facility waiver.

The delays, announced in an interim rule posted Monday in the Federal Register, will push back the start date of the cardiac care and orthopedic models and updates to the joint replacement model three months, to Oct. 1, 2017.

The effective date of the final rules was also pushed back, from today to May 20, 2017. It's the second time the rule's effective date has been changed — HHS postponed the date from Feb. 18 to March 21 in February, in order to allow time for the new administration to review the policies.

The delays may be a sign that bundled payment initiatives may be in danger under the new administration, according to some observers. In its interim rule, CMS stated that the delay is meant to give officials more time to review the policies, and make sure that providers have a full understanding of any changes that may come.

“This 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,” the interim rule reads.

The interim rule also notes that CMS will be accepting comments on the delay, with the possibility of pushing back the implementation date of the rule to Jan. 1, 2018. If the agency decides to delay the cardiac bundles, it will also push back the joint replacement expansion until Jan. 1, according to the rule.