Federal Policy
CMS Expands Joint Replacement Model Nationwide Through Medicare Program
CMS announced a nationwide expansion of its joint replacement bundled payment model through the Medicare program. The expansion builds on results from a previous demonstration that tested episode-based payments for hip and knee replacements. Medicare Advantage plans and traditional Medicare will implement the model across all states. The expansion does not directly affect Medicaid fee-for-service or managed care payment methodologies, though some dual-eligible beneficiaries may be affected if enrolled in Medicare Advantage.
Why it mattersThe expansion may affect care coordination for dual-eligible beneficiaries receiving joint replacements under Medicare coverage, requiring Medicaid MCOs to align supplemental services with Medicare episode-based payments.