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Federal Register / Vol. 86, No. 83 / Monday, May 3, 2021 / Rules and Regulations to the occurrence of a 3-day hospital stay, and the beneficiary is being transferred to or is considering a SNF
that would not qualify under the SNF 3day waiver in 510.610, the participant hospital must notify the beneficiary in accordance with paragraph b3i of this section that the beneficiary will be responsible for payment for the services furnished by the SNF during that stay, except those services that would be covered by Medicare Part B during a non-covered inpatient SNF stay.

16. Section 510.500 is amended by revising paragraphs c4i and ii to read as follows:
510.500 Sharing arrangements under the CJR model.

c
4
i For episodes beginning on or after April 1, 2016 and ending on or before September 30, 2021, in the case of a CJR
collaborator who is a physician or nonphysician practitioner, 50 percent of the Medicare-approved amounts under the PFS for items and services furnished by that physician or non-physician practitioner to the participant hospitals CJR beneficiaries during CJR model episodes that occurred during the same performance year for which the participant hospital accrued the internal cost savings or earned the reconciliation payment that comprises the gainsharing payment being made.
ii For episodes beginning on or after April 1, 2016 and ending on or before September 30, 2021, in the case of a CJR
collaborator that is a PGP or NPPGP, 50
percent of the Medicare-approved amounts under the PFS for items and services billed by that PGP or NPPGP
and furnished to the participant hospitals CJR beneficiaries by the PGP
members or NPPGP members respectively during CJR model episodes that occurred during the same performance year for which the participant hospital accrued the internal cost savings or earned the reconciliation payment that comprises the gainsharing payment being made.

17. Section 510.505 is amended by revising paragraphs b8i and ii to read as follows:
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510.505

Distribution arrangements.

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b
8
i For episodes beginning on or after April 1, 2016 and ending on or before September 30, 2021, in the case of a collaboration agent that is a physician or non-physician practitioner, 50 percent of the total Medicare-approved amounts under the PFS for items and services furnished by the collaboration agent to the participant hospitals CJR
beneficiaries during CJR model episodes that occurred during the same performance year for which the participant hospital accrued the internal cost savings or earned the reconciliation payment that comprises the gainsharing payment being distributed.
ii For episodes beginning on or after April 1, 2016 and ending on or before September 30, 2021, in the case of a collaboration agent that is a PGP or NPPGP, 50 percent of the total Medicare-approved amounts under the PFS for items and services billed by that PGP or NPPGP for items and services furnished by PGP members or NPPGP
member respectively to the participant hospitals CJR beneficiaries during CJR
model episodes that occurred during the same performance year for which the participant hospital accrued the internal cost savings or earned the reconciliation payment that comprises the gainsharing payment being distributed.

18. Section 510.506 is amended by revising paragraph b8 to read as follows:
510.506 Downstream distribution arrangements.

b
8 Except for a downstream distribution payment from a PGP to a PGP member that complies with 411.352g of this chapter, for episodes beginning on or after April 1, 2016 and ending on or before September 30, 2021
the total amount of downstream distribution payments for a performance year paid to a downstream collaboration agent who is a physician or nonphysician practitioner and is either a member of a PGP or a member of an NPPGP must not exceed 50 percent of the total Medicare-approved amounts under the PFS for items and services furnished by the downstream collaboration agent to the participant hospitals CJR beneficiaries during a CJR
model episode that occurred during the
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same performance year for which the participant hospital accrued the internal cost savings or earned the reconciliation payment that comprises the distribution payment being distributed.

510.600

Amended
19. Section 510.600 is amended in paragraph b1 by removing the phrase an anchor hospitalization and adding in its place the phrase an anchor hospitalization or anchor procedure.
20. Section 510.610 is amended a. By revising paragraph a; and b. In paragraph b1, removing the phrase qualifying inpatient stay. and adding in its place the phrase qualifying inpatient stay or anchor procedure.
The revision reads as follows:

510.610

Waiver of SNF 3-day rule.

a Waiver of the SNF 3-day rule1
Performance yeari Performance years 2 through 5. For episodes being tested in performance years 2 through 5
of the CJR model, CMS waives the SNF
3-day rule for coverage of a SNF stay for a beneficiary who is a CJR beneficiary on the date of discharge from the anchor hospitalization, but only if the SNF is identified on the applicable calendar quarter list of qualified SNFs at the time of the CJR beneficiarys admission to the SNF.
ii Performance years 6 through 8. A
For episodes being tested in performance years 6 through 8 of the CJR model, CMS waives the SNF 3-day rule for coverage of a SNF stay within 30 days of the date of discharge from the anchor hospitalization for a beneficiary who is a CJR beneficiary on the date of discharge from the anchor hospitalization, but only if the SNF is identified on the applicable calendar quarter list of qualified SNFs at the time of the CJR beneficiarys admission to the SNF.
B For episodes being tested in performance years 6 through 8 of the CJR model, CMS waives the SNF 3-day rule for coverage of a SNF stay within 30 days of the date of service of the anchor procedure for a beneficiary who is a CJR beneficiary on the date of service of the anchor procedure, but only if the SNF is identified on the applicable calendar quarter list of qualified SNFs at the time of the CJR
beneficiarys admission to the SNF.

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