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Federal Register / Vol. 86, No. 83 / Monday, May 3, 2021 / Rules and Regulations
510.315 Composite quality scores for determining reconciliation payment eligibility and quality incentive payments.

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d Quality improvement points. 1
For performance year 1, if a participant hospitals quality performance percentile on an individual measure described in 510.400a increases from the corresponding time period in the previous year by at least 2 deciles on the performance percentile scale, then the hospitals is eligible to receive quality improvement points equal to 10 percent of the total available point for that individual measure up to a maximum composite quality score of 20 points.
2 For each of performance years 2
through 4, each of performance year subsets 5.1 and 5.2, and each of performance years 6 through 8, if a participant hospitals quality performance percentile on an individual measure described in 510.400a increases from the previous performance year or performance year subset by at least 2 deciles on the performance percentile scale, then the hospital is eligible to receive quality improvement points equal to 10 percent of the total available point for that individual measure up to a maximum composite quality score of 20 points.

f
1 Performance years 1 through 5. For performance years 1 through 5
i A 1.0 percentage point reduction to the effective discount factor or applicable discount factor for participant hospitals with good quality performance, defined as composite quality scores that are greater than or equal to 6.9 and less than or equal to 15.0; or ii A 1.5 percentage point reduction to the effective discount factor or applicable discount factor for participant hospitals with excellent quality performance, defined as composite quality scores that are greater than 15.0.
2 Performance years 6 through 8. For performance years 6 through 8
i A 1.5-percentage point reduction to the effective discount factor or applicable discount factor for participant hospitals with good quality performance, defined as composite quality scores that are greater than or equal to 6.9 and less than or equal to 15.0; or ii A 3-percentage point reduction to the effective discount factor or applicable discount factor for participant hospitals with excellent quality performance, defined as
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composite quality scores that are greater than 15.0.

14. Section 510.400 is amended a. In paragraph b2i by removing the phrase over the 5 years and adding in its place the phrase over the first 5 years;
b. In paragraph b2ii introductory text by removing the phrase of the program and adding in its place the phrase of the model; and c. By adding paragraph b4.
The addition reads as follows:
510.400

Quality measures and reporting.

b
4 For years 6 through 8 of the model the following data are requested by CMS
for each performance period as follows:
i Year 6 October 1, 2021 to December 31, 2022. Submit A Post-operative data on primary elective THA/TKA procedures for 80%
or 200 procedures performed between July 1, 2019 and June 30, 2020; and B Pre-operative data on primary elective THA/TKA procedures for 80%
or 300 procedures performed between July 1, 2021 and June 30, 2022.
ii Year 7 2023. Submit A Post-operative data on primary elective THA/TKA procedures for 80%
or 300 procedures performed between July 1, 2021 and June 30, 2022; and B Pre-operative data on primary elective THA/TKA procedures for 85%
or 400 procedures performed between July 1, 2022 and June 30, 2023.
iii Year 8 2024. Submit A Post-operative data on primary elective THA/TKA procedures for 85%
or 400 procedures performed between July 1, 2022 and June 30, 2023; and B Pre-operative data on primary elective THA/TKA procedures for 90%
or 500 procedures performed between July 1, 2023 and June 30, 2024.

15. Section 510.405 is amended by revising paragraphs b1 and 3 to read as follows:
510.405 Beneficiary choice and beneficiary notification.

b
1 Participant hospital beneficiary notificationi Notification to beneficiaries. Each participant hospital must provide written notification to any Medicare beneficiary that meets the criteria in 510.205 of his or her inclusion in the CJR model.
ii Timing of notification. Prior to discharge from the anchor hospitalization, or prior to discharge
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from the anchor procedure, as applicable, the participant hospital must provide the CJR beneficiary with a participant hospital beneficiary notification as described in paragraph b1iv of this section.
iii List of beneficaries receiving a notification. The participant hospital must be able to generate a list of all beneficiaries receiving such notification, including the date on which the notification was provided to the beneficiary, to CMS or its designee upon request.
iv Content of notification. The beneficiary notification must contain all of the following:
A A detailed explanation of the model and how it might be expected to affect the beneficiarys care.
B Notification that the beneficiary retains freedom of choice to choose providers and services.
C Explanation of how patients can access care records and claims data through an available patient portal, and how they can share access to their Blue Button electronic health information with caregivers.
D A statement that all existing Medicare beneficiary protections continue to be available to the beneficiary. These include the ability to report concerns of substandard care to Quality Improvement Organizations or the 1800MEDICARE helpline.
E A list of the providers, suppliers, and ACOs with whom the CJR
participant hospital has a sharing arrangement. This requirement may be fulfilled by the participant hospital including in the detailed notification a Web address where beneficiaries may access the list.

3 Discharge planning notice. A
participant hospital must provide the beneficiary with a written notice of any potential financial liability associated with non-covered services recommended or presented as an option as part of discharge planning, no later than the time that the beneficiary discusses a particular post-acute care option or at the time the beneficiary is discharged from an anchor procedure or anchor hospitalization, whichever occurs earlier.
i If the participant hospital knows or should have known that the beneficiary is considering or has decided to receive a non-covered post-acute care service or other non-covered associated service or supply, the participant hospital must notify the beneficiary that the service would not be covered by Medicare.
ii If the participant hospital is discharging a beneficiary to a SNF prior
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