(a) Episodes tested in the CJR model include only those in which care is furnished to beneficiaries who meet all of the following criteria upon admission to the anchor hospitalization:
(1) Are enrolled in Medicare Parts A and Part B.
(2) Eligibility for Medicare is not on the basis of end stage renal disease, as described in § 406.13 of this chapter.
(3) Are not enrolled in any managed care plan (for example, Medicare Advantage, health care prepayment plans, or cost-based health maintenance organizations).
(4) Are not covered under a United Mine Workers of America health care plan.
(5) Have Medicare as their primary payer.
(6) For episodes beginning on or after July 1, 2017, are not prospectively assigned to -
(i) An ACO in the Next Generation ACO model;
(ii) An ACO in a track of the Comprehensive ESRD Care Model incorporating downside risk for financial losses; or
(iii) A Shared Savings Program ACO in the ENHANCED track (formerly Track 3).
(b) If at any time during the episode a beneficiary no longer meets all of the criteria in this section, the episode is canceled in accordance with § 510.210(b).
[80 FR 73540, Nov. 24, 2015, as amended at 82 FR 613, Jan. 3, 2017; 86 FR 23571, May 3, 2021]