82 FR 10961 - Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model; Delay of Effective Date

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 82, Issue 32 (February 17, 2017)

Page Range		10961-10962
FR Document		2017-03347

In accordance with the memorandum of January 20, 2017, from the Assistant to the President and Chief of Staff, entitled ``Regulatory Freeze Pending Review'', this action delays for 60 days from the date of the memorandum the effective date of the rule entitled ``Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model'' published in the January 3, 2017 Federal Register (82 FR 180). That rule implements three new Medicare Parts A and B episode payment models and a Cardiac Rehabilitation (CR) Incentive Payment model, and implements changes to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act (the Act). Under the three new episode payment models, acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-for-service beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. Under the CR Incentive Payment model, acute care hospitals in certain selected geographic areas will receive retrospective incentive payments for beneficiary utilization of cardiac rehabilitation/intensive cardiac rehabilitation services during the 90 days following discharge from a hospitalization treatment of an acute myocardial infarction or coronary artery bypass graft surgery. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

Federal Register, Volume 82 Issue 32 (Friday, February 17, 2017)

[Federal Register Volume 82, Number 32 (Friday, February 17, 2017)]
[Rules and Regulations]
[Pages 10961-10962]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-03347]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 510 and 512

[CMS-5519-F2]
RIN 0938-AS90


Medicare Program; Advancing Care Coordination Through Episode 
Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; 
and Changes to the Comprehensive Care for Joint Replacement Model; 
Delay of Effective Date

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule; delay of effective date.

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SUMMARY: In accordance with the memorandum of January 20, 2017, from 
the Assistant to the President and Chief of Staff, entitled 
``Regulatory Freeze Pending Review'', this action delays for 60 days 
from the date of the memorandum the effective date of the rule entitled 
``Advancing Care Coordination Through Episode Payment Models (EPMs); 
Cardiac Rehabilitation Incentive Payment Model; and Changes to the 
Comprehensive Care for Joint Replacement Model'' published in the 
January 3, 2017 Federal Register (82 FR 180). That rule implements 
three new Medicare Parts A and B episode payment models and a Cardiac 
Rehabilitation (CR) Incentive Payment model, and implements changes to 
the existing Comprehensive Care for Joint Replacement model under 
section 1115A of the Social Security Act (the Act). Under the three new 
episode payment models, acute care hospitals in certain selected 
geographic areas will participate in retrospective episode payment 
models targeting care for Medicare fee-for-service beneficiaries 
receiving services during acute myocardial infarction, coronary artery 
bypass graft, and surgical hip/femur fracture treatment episodes. All 
related care within 90 days of hospital discharge will be included in 
the episode of care. Under the CR Incentive Payment model, acute care 
hospitals in certain selected geographic areas will receive 
retrospective incentive payments for beneficiary utilization of cardiac 
rehabilitation/intensive cardiac rehabilitation services during the 90 
days following discharge from a hospitalization treatment of an acute 
myocardial infarction or coronary artery bypass graft surgery. We 
believe these models will further our goals of improving the efficiency 
and quality of care for Medicare beneficiaries receiving care for these 
common clinical conditions and procedures.

DATES: 
    Effective date: The effective date of the final rule published in 
the January 3, 2017 Federal Register (82 FR 180) for provisions that 
were to become effective on February 18, 2017, is delayed to a new 
effective date of March 21, 2017. The provisions contained in the 
following amendatory instructions remain effective July 1, 2017: Number 
3 amending 42 CFR 510.2; number 4 adding 42 CFR 510.110; number 6 
amending 42 CFR 510.120; number 14 amending 42 CFR 510.405; number 15 
amending 42 CFR 510.410; number 16 revising 42 CFR 510.500; number 17 
revising 42 CFR 510.505; number 18 adding 42 CFR 510.506; and number 19 
amending 42 CFR 510.515.
    Applicability date: The regulations at 42 CFR part 512 are 
applicable on July 1, 2017.

[[Page 10962]]


FOR FURTHER INFORMATION CONTACT: Nora Fleming, (410) 786-6908.
    For questions related to the EPMs: [email protected]. For 
questions related to the CJR model: [email protected].

SUPPLEMENTARY INFORMATION: To the extent that section 553 of the 
Administrative Procedure Act (APA) applies to this action to 
temporarily delay the rule's effective date, it is exempt from notice 
and comment because it constitutes a rule of procedure under 5 U.S.C. 
553(b)(A). Furthermore, 5 U.S.C. 553(b)(B) permits a waiver of prior 
notice and comment if an agency finds good cause that a notice-and-
comment procedure is impracticable, unnecessary, or contrary to the 
public interest. Similarly, section 1871 of the Act, which normally 
requires prior notice and a 60-day public comment period for rules that 
establish or change a substantive legal standard, permits waiver of the 
comment period when there is good cause for an exception under 5 U.S.C. 
553(b)(B). In addition, the requirement under section 553(d) of the APA 
for a 30-day delay in the effective date of a rule can be waived for 
good cause. Consistent with the Assistant to the President and Chief of 
Staff's memorandum of January 20, 2017, we are postponing for 60 days 
from the date of the memorandum, the effective date of the final rule 
to allow Department officials the opportunity for further review and 
consideration of new regulations. Moreover, we are exercising no 
discretion in implementing this specific provision of the memorandum. 
As a result, undertaking notice and comment procedure for this delay is 
unnecessary and contrary to the public interest, and we find good cause 
to waive the notice and comment requirements. For these same reasons, 
we find good cause to waive the 30-day delay in effective date provided 
for in 5 U.S.C. 553(d). Based on these findings, this rule is effective 
immediately upon publication in the Federal Register.

    Dated: February 10, 2017.
Patrick H. Conway,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Approved: February 15, 2017.
Thomas E. Price,
Secretary, Department of Health and Human Services.
[FR Doc. 2017-03347 Filed 2-15-17; 4:15 pm]
BILLING CODE 4120-01-P

10962 Federal Register / Vol. 82, No. 32 / Friday, February 17, 2017 / Rules and Regulations

FOR FURTHER INFORMATION CONTACT: DEPARTMENT OF HOMELAND body adopts adequate floodplain
Nora Fleming, (410) 786–6908. SECURITY management measures with effective
For questions related to the EPMs: enforcement measures. The
Federal Emergency Management communities listed in this document no
EPMRULE@cms.hhs.gov. For questions
Agency longer meet that statutory requirement
related to the CJR model: CJR@
for compliance with program
cms.hhs.gov. 44 CFR Part 64 regulations, 44 CFR part 59.
SUPPLEMENTARY INFORMATION: To the [Docket ID FEMA–2016–0002; Internal Accordingly, the communities will be
extent that section 553 of the Agency Docket No. FEMA–8467] suspended on the effective date in the
Administrative Procedure Act (APA) third column. As of that date, flood
applies to this action to temporarily Suspension of Community Eligibility insurance will no longer be available in
delay the rule’s effective date, it is the community. We recognize that some
AGENCY: Federal Emergency of these communities may adopt and
exempt from notice and comment Management Agency, DHS.
because it constitutes a rule of submit the required documentation of
ACTION: Final rule. legally enforceable floodplain
procedure under 5 U.S.C. 553(b)(A).
management measures after this rule is
Furthermore, 5 U.S.C. 553(b)(B) permits SUMMARY: This rule identifies
published but prior to the actual
a waiver of prior notice and comment if communities where the sale of flood
suspension date. These communities
an agency finds good cause that a insurance has been authorized under
will not be suspended and will continue
notice-and-comment procedure is the National Flood Insurance Program
to be eligible for the sale of NFIP flood
impracticable, unnecessary, or contrary (NFIP) that are scheduled for
insurance. A notice withdrawing the
to the public interest. Similarly, section suspension on the effective dates listed
suspension of such communities will be
1871 of the Act, which normally within this rule because of
published in the Federal Register.
requires prior notice and a 60-day noncompliance with the floodplain
management requirements of the In addition, FEMA publishes a Flood
public comment period for rules that Insurance Rate Map (FIRM) that
establish or change a substantive legal program. If the Federal Emergency
Management Agency (FEMA) receives identifies the Special Flood Hazard
standard, permits waiver of the Areas (SFHAs) in these communities.
documentation that the community has
comment period when there is good The date of the FIRM, if one has been
adopted the required floodplain
cause for an exception under 5 U.S.C. published, is indicated in the fourth
management measures prior to the
553(b)(B). In addition, the requirement effective suspension date given in this column of the table. No direct Federal
under section 553(d) of the APA for a rule, the suspension will not occur and financial assistance (except assistance
30-day delay in the effective date of a a notice of this will be provided by pursuant to the Robert T. Stafford
rule can be waived for good cause. publication in the Federal Register on a Disaster Relief and Emergency
Consistent with the Assistant to the subsequent date. Also, information Assistance Act not in connection with a
President and Chief of Staff’s identifying the current participation flood) may be provided for construction
memorandum of January 20, 2017, we status of a community can be obtained or acquisition of buildings in identified
are postponing for 60 days from the date from FEMA’s Community Status Book SFHAs for communities not
of the memorandum, the effective date (CSB). The CSB is available at https:// participating in the NFIP and identified
of the final rule to allow Department www.fema.gov/national-flood- for more than a year on FEMA’s initial
officials the opportunity for further insurance-program-community-status- FIRM for the community as having
review and consideration of new book. flood-prone areas (section 202(a) of the
regulations. Moreover, we are exercising Flood Disaster Protection Act of 1973,
DATES: The effective date of each 42 U.S.C. 4106(a), as amended). This
no discretion in implementing this community’s scheduled suspension is prohibition against certain types of
specific provision of the memorandum. the third date (‘‘Susp.’’) listed in the Federal assistance becomes effective for
As a result, undertaking notice and third column of the following tables. the communities listed on the date
comment procedure for this delay is FOR FURTHER INFORMATION CONTACT: If shown in the last column. The
unnecessary and contrary to the public you want to determine whether a Administrator finds that notice and
interest, and we find good cause to particular community was suspended public comment procedures under 5
waive the notice and comment on the suspension date or for further U.S.C. 553(b), are impracticable and
requirements. For these same reasons, information, contact Patricia Suber, unnecessary because communities listed
we find good cause to waive the 30-day Federal Insurance and Mitigation in this final rule have been adequately
delay in effective date provided for in 5 Administration, Federal Emergency notified.
U.S.C. 553(d). Based on these findings, Management Agency, 400 C Street SW., Each community receives 6-month,
this rule is effective immediately upon Washington, DC 20472, (202) 646–4149. 90-day, and 30-day notification letters
publication in the Federal Register. SUPPLEMENTARY INFORMATION: The NFIP addressed to the Chief Executive Officer
Dated: February 10, 2017. enables property owners to purchase stating that the community will be
Federal flood insurance that is not suspended unless the required
Patrick H. Conway,
otherwise generally available from floodplain management measures are
Acting Administrator, Centers for Medicare met prior to the effective suspension
private insurers. In return, communities
& Medicaid Services.
agree to adopt and administer local date. Since these notifications were
mstockstill on DSK3G9T082PROD with RULES

Approved: February 15, 2017. floodplain management measures aimed made, this final rule may take effect
Thomas E. Price, at protecting lives and new construction within less than 30 days.
Secretary, Department of Health and Human from future flooding. Section 1315 of National Environmental Policy Act.
Services. the National Flood Insurance Act of FEMA has determined that the
[FR Doc. 2017–03347 Filed 2–15–17; 4:15 pm] 1968, as amended, 42 U.S.C. 4022, community suspension(s) included in
BILLING CODE 4120–01–P prohibits the sale of NFIP flood this rule is a non-discretionary action
insurance unless an appropriate public and therefore the National

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Document Created: 2017-02-17 00:28:40
Document Modified: 2017-02-17 00:28:40

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Rules and Regulations
Action		Final rule; delay of effective date.
Dates		Effective date: The effective date of the final rule published in the January 3, 2017 Federal Register (82 FR 180) for provisions that were to become effective on February 18, 2017, is delayed to a new effective date of March 21, 2017. The provisions contained in the following amendatory instructions remain effective July 1, 2017: Number 3 amending 42 CFR 510.2; number 4 adding 42 CFR 510.110; number 6 amending 42 CFR 510.120; number 14 amending 42 CFR 510.405; number 15 amending 42 CFR 510.410; number 16 revising 42 CFR 510.500; number 17 revising 42 CFR 510.505; number 18 adding 42 CFR 510.506; and number 19 amending 42 CFR 510.515.
Contact		Nora Fleming, (410) 786-6908.
FR Citation		82 FR 10961
RIN Number		0938-AS90
CFR Citation		42 CFR 510 42 CFR 512

82 FR 10961 - Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model; Delay of Effective Date

DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare & Medicaid Services

Federal Register Volume 82, Issue 32 (February 17, 2017)

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services