Comprehensive Care for Joint Replacement (CJR) Program Collaborator Selection Policy
Effective Date: 4/1/2016
Sebastian River Medical Center, designated by the Centers for Medicare and Medicaid Services (CMS) to participate in the CMS CJR program, maintains written policies for selecting providers and suppliers for sharing risk and gains as CJR collaborators as follows:
CJR Collaborator selection shall be made in accordance with all relevant laws and regulations, including the applicable fraud and abuse laws and all applicable payment and coverage requirements as defined for CMS model and the CJR programs. Selection criteria are not based directly or indirectly on the volume or value of referrals or business otherwise generated by, between, or among the hospital, CJR collaborator, and any individual or entity affiliated with the hospital or CJR collaborator.
Activities related to promoting accountability for the quality, cost, and overall care for CJR beneficiaries, including managing and coordinating care; encouraging investment in infrastructure enabling technologies and redesigned care processes for high quality and efficient service delivery; the provision of items and services during a CJR episode in a manner that reduces costs and improves quality; or carrying out any other obligation or duty under CJR.
one of the following Medicare-enrolled persons or entities that enters into a sharing arrangement:
(1) Skilled nursing facility (SNF); (2) Home health agency (HHA); (3) Long-term care hospital (LTCH); (4) Inpatient rehabilitation facility (IRF); (5) Physician; (6) Nonphysician practitioner; (7) Therapist in private practice; (8) Comprehensive Outpatient Rehabilitation Facility (CORF); (9) Provider of outpatient therapy services; (10) Physician Group Practice (PGP); (11) Hospital; (12) Critical Access Hospital (CAH); (13) Non-Physician Provider Group Practice (NPPGP); (14) Therapy Group Practice (TGP); (15) Accountable Care Organization (ACO).
Privileged to perform a surgical procedure in MS DRGs 469, 470, 480, 481, 482
Eligible to participate in Medicare
Commitment to participate in CJR activities, including:
Attends 75% of Care Redesign Workgroup meetings
Attends Quarterly Data Review meetings
Notifies hospital facility designee of at least 80% of elective CJR admissions at least 14 days in advance in a mutually determined format