[Federal Register Volume 85, Number 80 (Friday, April 24, 2020)]
[Proposed Rules]
[Page 22978]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-08717]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 510

[CMS-5529-N]
RIN 0938-AU01


Medicare Program: Comprehensive Care for Joint Replacement Model 
Three-Year Extension and Changes To Episode Definition and Pricing; 
Extension of Comment Period

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Proposed rule; extension of comment period.

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SUMMARY: This document extends the comment period for the proposed rule 
titled ``Medicare Program: Comprehensive Care for Joint Replacement 
Model Three-Year Extension and Changes to Episode Definition and 
Pricing'' that was published in the February 24, 2020 Federal Register. 
The comment period for the proposed rule, which would end on April 24, 
2020, is extended until June 23, 2020.

DATES: The comment period for the proposed rule (85 FR 10516) is 
extended to 5 p.m., eastern daylight time, on June 23, 2020.

ADDRESSES: You may submit comments as outlined in the February 24, 2020 
proposed rule (85 FR 10516). Please choose only one method listed.

FOR FURTHER INFORMATION CONTACT: Bobbie Knickman, (410) 786-4161. 
Heather Holsey, (410) 786-0028.

SUPPLEMENTARY INFORMATION: 
    Inspection of Public Comments: All comments received before the 
close of the comment period shall be made available for viewing by the 
public, including any personally identifiable or confidential business 
information that is included in a comment. We will post all comments 
received before the close of the comment period on the following 
website as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that website to 
view public comments.
    In the February 24, 2020 Federal Register (85 FR 10516), we 
published a proposed rule titled ``Medicare Program: Comprehensive Care 
for Joint Replacement Model Three-Year Extension and Changes to Episode 
Definition and Pricing.'' The February 2020 proposed rule solicited 
public comments on our proposals to revise certain aspects of the 
Comprehensive Care for Joint Replacement (CJR) model including the 
episode of care definition, the target price calculation, the 
reconciliation process, the beneficiary notice requirements and the 
appeals process. In addition, for proposed performance years 6 through 
8, it would eliminate the 50 percent cap on gainsharing payments, 
distribution payments, and downstream distribution payments for certain 
recipients. This proposed rule would also extend the additional 
flexibilities provided to hospitals related to certain Medicare program 
rules consistent with the revised episode of care definition. 
Additionally, the proposed rule would allow time to test the proposed 
changes by extending the length of the CJR model for an additional 3 
years, through December 31, 2023, for certain participant hospitals. 
Finally, it solicits comment on how we might best conceptualize and 
design a future bundled payment model focused on lower extremity joint 
replacements (LEJR) procedures performed in the ambulatory surgical 
center (ASC) setting and could involve shared financial accountability.
    In the April 6, 2020 Federal Register (85 FR 19230), we published 
an interim final rule with comment period (IFC) in order to ensure 
continuity of CJR model operations in participant hospitals during the 
public health emergency (PHE) for the COVID-19 pandemic so that we do 
not create any additional disruptions to the standard care procedures 
hospitals have in place during this challenging time, implementing a 3-
month extension of CJR Performance Year 5, such that the end of 
Performance Year 5 is changed from December 31, 2020 to March 31, 2021. 
Additionally, the April 6, 2020 IFC amends the CJR extreme and 
uncontrollable circumstances policy to account for all participant 
hospitals affected by the PHE for the COVID-19 pandemic, such that for 
a fracture or non-fracture episode with a date of admission to the 
anchor hospitalization that is on or within 30 days before the date 
that the emergency period began or that occurs through the termination 
of the emergency period, actual episode payments are capped at the 
performance year target price determined for the applicable episode.
    Further, we recognize that hospitals are focused on the COVID-19 
pandemic. Given the challenges to the health care delivery system in 
responding to COVID-19 cases we want to be considerate of the medical 
community's ability to focus on reviewing the proposed rule and 
submitting comments given their current extraordinary focus on patient 
care during the COVID-19 pandemic. In order to maximize the opportunity 
for the public to provide meaningful input to CMS, we believe it is 
important to allow additional time for the public to prepare comments 
on the February 2020 proposed rule. Therefore, we are extending the 
comment period for the proposed rule by 60 days. This document 
announces the extension of the public comment period for the proposed 
rule, which will now end at 5 p.m., eastern daylight time, on June 23, 
2020.
    The Administrator of the Centers for Medicare & Medicaid Services 
(CMS), Seema Verma, having reviewed and approved this document, 
authorizes Evell J. Barco Holland, who is the Federal Register Liaison, 
to electronically sign this document for purposes of publication in the 
Federal Register.

    Dated: April 14, 2020.
Evell J. Barco Holland,
Federal Register Liaison, Department of Health and Human Services.
[FR Doc. 2020-08717 Filed 4-23-20; 8:45 am]
 BILLING CODE 4120-01-P