FIRST MANDATORY NATIONWIDE BUNDLING MODEL: CJR-X FINALIZED

On July 31, 2027, CMS released the FY2027 Hospital Inpatient PPS Final Rule.

This rule included an update significant to Skilled Nursing Facilities.

CJR-X (Comprehensive Joint Replacement – Expanded)

CJR: Comprehensive Joint Replacement, was a Medicare A bundling model that ran for 8 years from 2016 – 2024 in 34 locations in 20 states.
It included only one diagnosis: LEJR: Lower Extremity Joint Replacement (hip & knee).
Due to its success in reducing spending without reducing quality, CMS is now expanding this model nationwide.
CJR-X will be the first bundling model that will be mandatory nationwide for all hospitals in the 50 states with very limited exceptions.
The episode of care is the hospital plus 90 days post-acute care, which includes any applicable SNF stay!
Hospitals will receive reward payments if they reduce spending while still meeting certain quality measures.

How does this affect the SNF?

Hospitals will want to partner with preferred SNF providers who have good Quality Measure performance and few re-hospitalizations.
Hospitals will try to divert patients home and away from the SNF, and require shorter LOS for those residents who do admit to the SNF.
SNFs with 3 or more starts may utilize the 3-Day waiver for these patients.

CJR-X is scheduled to begin January 1, 2028.

The FY 2027 IPPS and LTCH PPS final rule (CMS-1849-F) can be viewed on the Federal Register at: https://www.federalregister.gov/d/2026-15833

If you have any questions or need additional information, please email us at: