The Centers for Medicare and Medicaid Services (CMS) has
proposed a new mandatory bundled payment model, the
Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, in the
FY 2027 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule. CMS stated that the original CJR model generated Medicare savings while maintaining quality, which it cited as the basis for proposing a nationwide expansion through CJR-X.
If finalized as proposed, the first performance year (PY) would begin on October 1, 2027.
Proposed Model OverviewThe proposed CJR-X model would expand the original CJR model nationwide and apply to all Medicare fee-for-service beneficiaries undergoing lower extremity joint replacements – including hip, knee, and ankle procedures – performed in both inpatient and outpatient hospital settings.
Similar to CJR and the current TEAM models:
- Acute care hospitals would be the formal model participants.
- SNF and other PAC providers may participate as downstream participants (collaborators).
- Most IPPS hospitals would be required to participate if finalized, with exceptions for those participating in TEAM, Maryland hospitals, Ambulatory Surgery Centers (ASCs) and hospitals not paid under the IPPS and Outpatient Prospective Payment System.
Under the proposal, participating hospitals would be financially accountable for the cost and quality of care across a 90-day episode, beginning with the inpatient hospital admission or outpatient procedure and including related Medicare Parts A and B services, with limited exceptions. Post-acute care, including skilled nursing facility (SNF) services, would be included in the episode. The proposal also includes the 3-day SNF waiver, allowing eligible patients to be admitted to a SNF without a prior three-day hospital stay.
Please contact AHCA's Population Health Policy Analyst
Rohini Achal or
Nisha Hammel, Vice President, Reimbursement Policy & Population Health with any questions. The model
FAQs are also available.