CMS Proposes Rule to Cancel Episode Payment Model (EPM) and the Cardiac Rehabilitation Incentive Program (CR)

By J.C. Rivera, Mainstreet Investment

Centers for Medicare & Medicaid Services (CMS) recently proposed a rule entitled "Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model" (82 Fed. Red. 39310 ) that would cancel the EPM and CR bundled payment programs created per a final rule on December 20, 2016 (42 CFR Parts 512). Both programs were mandatory and scheduled to begin on January 1, 2018. CMS did note that there has been opposition to the mandatory nature of the programs.

The same rule proposes changes to the Comprehensive Joint Replacement (CJR) program (42 CFR Parts 510) by (i) reducing (approximately one-half) the number of hospitals currently required to participate in CJR, and (ii) giving a one-time election, with a deadline of January 31, 2018, to the hospitals that are no longer required to participate in the program.  Otherwise, the CJR program remains largely unchanged since its April 1, 2016 inception.

In a press release announcing the proposed rule, CMS stated that it expects to increase opportunities for providers to participate in voluntary initiatives rather than large mandatory episode payment model efforts. Seema Verma, an administrator for CMS, stated, “Stakeholders have asked for more input on the design of these models. These changes make this possible and give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries.” 

The deadline to submit public comments on the proposed rule is October 16, 2017 by 5:00 p.m. EDT. 

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