Comprehensive Care for Joint Replacement (CJR)

CJR Waivers

CJR Waivers

CJR Waivers

• In order to make the implementation and operation of the CJR program more efficient and potentially more effective, CMS is introducing a number of program waivers

Home Health

• CMS is waiving the “incident to” direct supervision requirements for up to nine post-discharge home health visits for CJR beneficiaries who are not homebound or do not otherwise qualify for home health services.

Home Health

• The services must be provided by “auxiliary personnel” (employed, contracted or leased employees of the patient’s physician or the same employing organization as the physician).

Home Health

• Since these visits are expected to be less expensive to provide compared to those to patients who qualify for home health, they will be billed under the new HCPCS code G9490

Home Health

• HCPCS code G9490 will have an RVU value equal to HCPCS G9187, which is the code for a similar BPCI visit. CMS expects the payment for these visits to be approximately $50 per visit.

Telehealth Services

• For the CJR program, CMS is waiving the telehealth patient geographic requirements. CJR beneficiaries may be located in any region and receive telehealth services.

Telehealth Services

• CMS is also waiving the originating site requirement, so that services can be provided to beneficiaries in their home or place of residence when the relevant HCPCS code doesn’t preclude this.

Telehealth Services

• CMS created nine new HCPCS G-codes to report home telehealth visits furnished to CJR beneficiaries under the waiver.

• Only physicians and practitioners currently eligible to provide telehealth services may provide them under the CJR telehealth waivers.

Telehealth Services

• CMS will not pay a facility fee for telehealth services originating in a CJR beneficiary’s home.

SNF 3-Day Rule

• CMS is issuing a waiver of the SNF 3-day qualifying stay rule for CJR beneficiaries. Discharges under the waiver will qualify for SNF payment.

SNF 3-Day Rule

• Without the 3-day qualifying stay, CJR hospitals may discharge a CJR beneficiary only to a SNF with an overall star rating of three stars or better for at least seven of the prior twelve months. • CMS will provide a list of SNFs that qualify

under this waiver and update the list quarterly.

SNF 3-Day Rule

• This waiver will be good for 30 days after discharge. The beneficiary must meet CJR eligibility requirements at the time of the SNF admission.

• CJR beneficiaries may still be discharged to any SNF, regardless of star rating, after a 3-day qualifying stay.

SNF 3-Day Rule

• This waiver won’t be available during the first performance year. CMS will issue billing instructions for the waiver prior to the start of performance year two.

• CMS will issue these waivers as needed.

SNF 3-Day Rule

• No Fraud and Abuse waivers are being issued due to the CJR program.

To download the full CJR report, click on the image below