In a move the Centers for Medicare & Medicaid Services cites as a reaction to President Donald Trump's regulatory freeze, CMS announced that implementation of certain minor aspects of the final rule expanding Medicare mandatory bundled payment models will be delayed by approximately one month. 

The final rule is titled "Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR)" – and this announcement now delays implementation of certain minor parts from February 18, 2017 until March 21, 2017. Those parts include:

• clarification of overlap between mandatory bundled payment programs and existing accountable care organization based models;
   
• adjustments to quality score methodology in the ongoing CJR program; and
   
• establishment of tracks in the CJR program which will be deemed to meet criteria for advanced alternative payment models under MACRA.

While not immediately apparent in the announced rule, published February 17, 2017, the launch date for other significant parts of the final rule, including the new EPMs, the new incentive payment model associated with cardiac rehabilitation, and the expansion of the CJR program to hip and femur fractures will not be changed, and is set for July 1, 2017 – a fact later confirmed by an HHS spokesman.  As such, while the uncertainty continues, hospitals in designated MSAs should continue preparations for participation in the EPMs and the expanded version of CJR.

CMS indicates that the delay will allow compliance with the current regulatory freeze banning implementation of any new rules for the first 60 days of the new Administration. An HHS spokesman has confirmed that the delay will not impact the July 1, 2017, start date for the mandatory bundled payment based programs.

It should be noted that HHS Secretary Tom Price has previously sponsored legislation to delay implementation of CJR. He also signed a letter in the fall of 2016 imploring the CMS Administrator to stop the roll-out of any mandatory bundled payment models, concerned that these models threaten quality of care and overstep the agency’s authority.