Voglio sapere a riguardo di…

jbell on DSKJLSW7X2PROD with RULES2

Federal Register / Vol. 86, No. 83 / Monday, May 3, 2021 / Rules and Regulations initiate an episode would unnecessarily complicate the evaluation and limit the generalizability of the results affecting the ability of this model being certified in the future. Therefore, we did not propose to include additional participants in the proposed CJR model extension but rather solicited comment in section II.J. of this final rule on how a future LEJR model that incorporated other entities in addition to hospitals might be structured.
We received many comments related to future LEJR models and the incorporation of other entities in addition to hospitals. A summary of those comments can be found in section II.J. of this final rule.
In developing our risk adjustment methodology approach, although we proposed to calculate coefficients at the national level, we also considered calculating coefficients separately for each region or applying riskstandardization to the regional target price prior to applying the beneficiaryspecific risk score as noted earlier in section II.C.4. of this final rule Additional Episode-Level Risk Adjustment. As we believe regional differences in risk for CJR HCC count and age should already be accounted for via our region/MSDRG pricing strategy we proposed the computationally less complex national approach although we sought comment on a regional calculation of coefficients.
After consideration of the public comments we received, we are finalizing the proposed policy to calculate the risk adjustment coefficients at the national level without applying risk standardization to the regional target price prior to applying the beneficiary-specific risk score. A
summary of those comments and our responses can be found in section II.C.4.
of this final rule.
Finally, in developing our methodology for the market trend factor update calculation, we considered utilizing the regional median episode costs as a basis for the market trend factor update calculation, as medians are generally recognized as the preferred measure of central tendency for data that is not normally distributed.
However, we did not propose to use the median in the market trend factor update, as discussed in section II.C.6. of this final rule, because we determined using the mean only resulted in a small difference in effect the trend factors calculated using means were 0.01 higher than trend factors calculated using medians, and using the mean could benefit participant hospitals that is, increase target prices more compared to the median. Further, using the mean
VerDate Sep<11>2014

21:15 Apr 30, 2021

Jkt 253001

aligns the trend calculation with the methodology for deriving the target prices for the model, which also relies on the mean rather than the median.
After consideration of the public comments we received, we are finalizing the proposed policy to calculate the market trend factor using the mean of episode costs instead of the median. A summary of comments received regarding this alternative policy and our responses can be found in section II.C.6. of this final rule.
I, Elizabeth Richter, Acting Administrator of the Centers for Medicare & Medicaid Services, approved this document on April 23, 2021.
List of Subjects in 42 CFR Part 510
Administrative Practice and Procedure, Health facilities, Health professions, Medicare, and Reporting and recordkeeping requirements.
For the reasons set forth in the preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR
chapter IV as set forth below:
PART 510COMPREHENSIVE CARE
FOR JOINT REPLACEMENT MODEL
1. The authority citation for part 510
is revised to read as follows:

Authority: 42 U.S.C. 1302, 1315a, and 1395hh.

2. Section 510.2 is amended by:
a. Adding a definition for Age bracket risk adjustment factor;
b. Revising the definition of Anchor hospitalization;
c. Addng definitions forAnchor procedure, BPCI Advanced, CJR
HCC count risk adjustment factor, and Dual-eligibility risk adjustment factor;
d. Revising the definitions of Episode of care or Episode and Net payment reconciliation amount NPRA;
e. Adding the definitions for OPPS
and OP THA/OP TKA;
f. Revising the definitions of Participant hospital, Performance Year, Quality improvement points, and Reconciliation payment; and g. Adding the definition for Reconciliation target price.
The additions and revisions read as follows:

510.2

Definitions.

Age bracket risk adjustment factor means the coefficient of risk associated with a patients age bracket, calculated as described in 510.301a1.

Anchor hospitalization means the initial hospital stay upon admission for
PO 00000

Frm 00075

Fmt 4701

Sfmt 4700

23569

a lower extremity joint replacement, for which the institutional claim is billed through the IPPS. Anchor hospitalization also includes an inpatient hospital admission within 3
days after an outpatient Total Knee Arthroplasty TKA or Total Hip Arthroplasty THA.
Anchor procedure means a TKA or THA procedure that is permitted and paid for by Medicare when performed in a hospital outpatient department HOPD and billed through the OPPS, except when the beneficiary is admitted to an inpatient hospital stay within 3
days after the TKA or THA.

BPCI Advanced stands for the Bundled Payments for Care Improvement Advanced Model.

CJRHCC condition count risk adjustment factor means the coefficient of risk associated with a patients total number of CMS Hierarchical Condition Categories, calculated as described in 510.301a1.

Dual-eligibility risk adjustment factor means the coefficient of risk associated with beneficiaries that are eligible for full Medicaid benefits or beneficiaries that are not eligible for full Medicaid benefits, calculated as described in 510.301a1.

Episode of care or Episode means all Medicare Part A and B items and services described in 510.200b and excluding the items and services described in 510.200d that are furnished to a beneficiary described in 510.205 during the time period that begins with the beneficiarys admission to an anchor hospitalization or, on or after July 4, 2021, the date of admission to an anchor hospitalization or the date of the anchor procedure, as applicable, and ends on the 90th day after the following, as applicable:
1 The date of discharge from the anchor hospitalization with the day of discharge itself being counted as the first day of the 90-day post-discharge period; or 2 The date of service for the anchor procedure.

Net payment reconciliation amount NPRA means the amount determined in accordance with 510.305e or m.

OPPS stands for the outpatient prospective payment system.
OP THA/OP TKA means a total hip arthroplasty or total knee arthroplasty, respectively, for which the institutional
E:FRFM03MYR2.SGM

03MYR2