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Federal Register / Vol. 86, No. 83 / Monday, May 3, 2021 / Rules and Regulations
claim is billed by the hospital through the OPPS.

Participant hospital means one of the following:
1 During performance years 1 and 2
of the CJR model and the period from January 1, 2018 to January 31, 2018 of performance year 3, a hospital other than a hospital excepted under 510.100b with a CCN primary address located in one of the geographic areas selected for participation in the CJR model in accordance with 510.105.
2 Between February 1, 2018 and September 30, 2021 a hospital other than a hospital excepted under 510.100b that is one of the following:
i A hospital with a CCN primary address located in a mandatory MSA as of February 1, 2018 that is not a rural hospital or a low-volume hospital on that date.
ii A hospital that is a rural hospital or low-volume hospital with a CCN
primary address located in a mandatory MSA that makes an election to participate in the CJR model in accordance with 510.115.
iii A hospital with a CCN primary address located in a voluntary MSA that makes an election to participate in the CJR model in accordance with 510.115.
3 Beginning October 1, 2021, a hospital that is not a rural hospital or a low-volume hospital as defined in 510.2, as of July 4, 2021 based on the date of the CMS notification letter and not the effective date of the rural reclassification, if applicable with a CCN primary address located in a mandatory MSA.

Performance year means one of the years in which the CJR model is being tested. Performance years for the model correlate to calendar years with the exceptions of performance year 1, which is April 1, 2016 through December 31, 2016, performance year 5, which is January 1, 2020 through September 30, 2021, and performance year 6 which is October 1, 2021 through December 31, 2022. For reconciliation purposes, performance year 5 is divided into two subsets, performance year subset 5.1
January 1, 2020 through December 31, 2020 and performance year subset 5.2
January 1, 2021 through September 30, 2021.

Quality improvement points are points that CMS adds to a participant hospitals composite quality score for a measure if the hospitals performance
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percentile on an individual quality measure for performance years 2
through 4 and 6 through 8, or for performance year subsets of performance year 5, increases from the previous performance year or performance year subset by at least 2
deciles on the performance percentile scale, as described in 510.315d. For performance year 1, CMS adds quality improvement points to a participant hospitals composite quality score for a measure if the hospitals performance percentile on an individual quality measure increases from the corresponding time period in the previous year by at least 2 deciles on the performance percentile scale, as described in 510.315d.

Reconciliation payment means a payment made by CMS to a CJR
participant hospital as determined in accordance with 510.305f or l.

Reconciliation target price means, for performance years 6 through 8, the target price applied to an episode at reconciliation, as determined in accordance with 510.301.

3. Section 510.100 is amended by revising paragraph a to read as follows:
510.100

Episodes being tested.

a Initiation of an episode. An episode is initiated when, with respect to a beneficiary described in 510.205
1 The participant hospital admits the beneficiary for an anchor hospitalization; or 2 On or after July 4, 2021, an anchor procedure is performed at the participant hospital.

4. Section 510.105 is amended by adding paragraph a3 to read as follows:
510.105

Geographic areas.

a
3 Beginning with performance year 6, only the 34 MSAs designated as mandatory participation MSAs as of performance year 3.

5. Section 510.120 is amended by revising paragraph a introductory text to read as follows:
510.120 CJR participant hospital CEHRT
track requirements.

a CJR CEHRT use. For performance years 2 through 8, CJR participant hospitals choose either of the following:

6. Section 510.200 is amended by
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a. Revising paragraph a;
b. Adding paragraph b15;
c. Revising paragraph c;
d. Revising paragraphs d4
introductory text, and d6;
e. Adding paragraph d7
f. Revising paragraphs e2, e3
introductory text, and e4
introductory text; and g. Adding paragraph e5.
The revisions and additions read as follows:

510.200 Time periods, included and excluded services, and attribution.

a Time periods. All episodes must begin on or after April 1, 2016 and end on or before December 31, 2024.
b
15 The surgeons Part B claim for the LEJR procedure dated within the 3 days prior to an inpatient admission, if the LEJR procedure was performed at the participant hospital on an outpatient basis but the patient was subsequently admitted as an inpatient, resulting in an anchor hospitalization.
c Episode attribution. All items and services included in the episode are attributed to the participant hospital at which the anchor hospitalization or anchor procedure, as applicable, occurs.
d
4 Items and services unrelated to the anchor hospitalization or the anchor procedure. Excluded services include, but are not limited, to the following:

6 For performance years 1 through 4
and for performance year subsets 5.1
and 5.2, payments for otherwise included items and services in excess of 2 standard deviations above the mean regional episode payment in accordance with 510.300b5.
7 For performance years 6 through 8
only, payments for otherwise included items and services in excess of the 99th percentile of regional spending, ranked within each region, for each of the four MSDRG target price categories, as specified in 510.300a1 and 6, for performance years 6 through 8, in accordance with 510.300b5.

e
2 For performance years 1 through 5
only, on an annual basis, or more frequently as needed, CMS updates the list of excluded services to reflect annual coding changes or other issues brought to CMS attention.
3 For performance years 1 through 5
only, CMS applies the following standards when revising the list of excluded services for reasons other than to reflect annual coding changes:

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