MHA Shares Summary Of Final CJR-X Model

Within the calendar year 2027 Outpatient Prospective Payment System final payment and policy updates, the Centers for Medicare & Medicaid Services finalized expansion of the Comprehensive Care for Joint Replacement (CJR-X) Model with minimal structural changes from the proposed rule.

One notable change is a three-month delay in the start date, from Oct. 1, 2027, to Jan. 1, 2028. Performance periods will run on a standard calendar-year basis.

Key provisions that remain unchanged include the following.

• The model continues to apply to hospitals paid under the Inpatient PPS and OPPS, excluding hospitals located in Maryland and hospitals participating in the Transforming Episode Accountability Model.
• Hospitals will be held accountable for Medicare spending and quality of care for patients from the inpatient admission or outpatient procedure through 90 days after discharge.
• The model includes inpatient hip, knee and ankle replacements and reattachments under MS-DRGs 469, 470, 521 and 522, as well as outpatient hip and knee procedures under HCPCS codes 27130 and 27447.

Hospitals should use the additional time before implementation to evaluate episode spending, strengthen post-acute care partnerships and identify opportunities to improve quality performance. The Missouri Hospital Association will continue to monitor CMS guidance and share additional resources as implementation approaches.