The Centers for Medicare & Medicaid Services today finalized without changes its “extreme and uncontrollable circumstances” policy for hospitals participating in the Comprehensive Care for Joint Replacement Payment Model. Like the November 2017 interim final rule, the final rule provides flexibility in determining episode spending for CJR hospitals located in areas impacted by a major disaster declaration under the Stafford Act for which the Health and Human Services Secretary has temporarily waived certain Medicare requirements under Section 1135 of the Social Security Act. For example, the policy last year applied to certain hospitals in areas impacted by hurricanes and wildfires. “The AHA is pleased that CMS recognizes the many unique challenges presented to hospitals and health systems on the front-lines of providing patient and community care following natural disasters and public health emergencies and is modifying the CJR model to ensure that they are not unfairly penalized due to these circumstances,” said Joanna Hiatt Kim, AHA vice president of payment policy. “For example, CJR beneficiaries in emergency and disaster areas could require unplanned, and possibly extensive, health care services as a direct result of evacuations or emergency-related injuries. In addition, the hospitals themselves may have difficulty completing their quality reporting submissions under the program. They should not be held accountable for these types of circumstances that are well beyond their control.”