Subpart F. Subpart F—Comprehensive Care For Joint Replacement Expanded (CJR-X) Model

• General

  • SECTION § 512.600 - Basis and scope of subpart.
  • SECTION § 512.605 - Definitions.

• CJR-X Participation

  • SECTION § 512.610 - Mandatory participation.
  • SECTION § 512.615 - CJR-X APM options.

• Beneficiary Population

  • SECTION § 512.620 - Beneficiary inclusion criteria.
  • SECTION § 512.622 - Beneficiary notifications.

• Episode of Care

  • SECTION § 512.625 - Scope of episode.
  • SECTION § 512.630 - Determination of the episode.

• Quality Measures and Composite Quality Score

  • SECTION § 512.635 - Quality measures, composite quality score, and display of quality measures.

• Pricing Methodology

  • SECTION § 512.640 - Determination of preliminary target prices.
  • SECTION § 512.645 - Determination of reconciliation target prices.
  • SECTION § 512.650 - Reconciliation process and determination of the reconciliation payment or repayment amount.
  • SECTION § 512.652 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.
  • SECTION § 512.655 - Proration of payments for items and services that extend beyond an episode.
  • SECTION § 512.660 - Appeals process.

• Data Sharing

  • SECTION § 512.665 - Data sharing with CJR-X participants.

• Financial Arrangements and Beneficiary Incentives

  • SECTION § 512.670 - Sharing arrangements.
  • SECTION § 512.675 - Distribution arrangements.
  • SECTION § 512.680 - Downstream distribution arrangements.
  • SECTION § 512.685 - CJR-X beneficiary incentives.
  • SECTION § 512.690 - Application of the CMS-sponsored Model Arrangements and Patient Incentives Safe Harbor.

• Medicare Program Waivers

  • SECTION § 512.695 - CJR-X Medicare Program Waivers.