Comprehensive Care for Joint Replacement (CJR) Payment Reconciliation Task Order

Background

The Centers for Medicare & Medicaid Services (CMS), specifically the Center for Medicare & Medicaid Innovation (CMMI), is issuing a justification for an exception to fair opportunity regarding the Comprehensive Care for Joint Replacement (CJR) Payment Reconciliation Task Order. This action is necessary to operationalize the complex payment reconciliation methodology of the mandatory CJR model, which has been detailed in various Federal Register publications since 2015. The goal of this contract modification is to ensure continuity in the reconciliation process and support appeals related to the CJR model.

Work Details

The task order involves several critical services as part of the annual payment reconciliation process, including: 1) pulling all episode-related Medicare claims from the most recent performance year; 2) coordinating with a separate contractor to calculate a composite quality score for each participant; 3) calculating the final quality-adjusted target price for each participant; 4) calculating total performance period spending for each participant; 5) comparing amounts to determine if participants are entitled to a reconciliation payment or owe a repayment to CMS; and 6) creating and delivering detailed reconciliation reports to participants. Additional services include providing monthly data feeds to participant hospitals, technical assistance, and ad hoc episode analyses. The modification seeks to add a three-month option period from March 31, 2026, through June 30, 2026, to support CMMI's continuation of these processes.

Period of Performance

The base year of the original task order was from March 21, 2022, to March 20, 2023, with subsequent option years extending through March 20, 2026. The proposed modification adds an additional three-month option period from March 31, 2026, through June 30, 2026.

Place of Performance

The specific geographic location(s) where this contract will be performed are not explicitly provided in the documentation.