GroundRules
42 CFR 512.620: Beneficiary inclusion criteria.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER H—HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS
- PART 512—STANDARD PROVISIONS FOR MANDATORY INNOVATION CENTER MODELS AND SPECIFIC PROVISIONS FOR CERTAIN MODELS
- Subpart F—Comprehensive Care For Joint Replacement Expanded (CJR-X) Model
(a) An individual is a CJR-X beneficiary if, based on a 180-day lookback period that ends on the day prior to an anchor procedure or anchor hospitalization, the individual—
(1) Is enrolled in Medicare Parts A and B;
(2) Has Medicare as their primary payer;
(3) Is not eligible for Medicare on the basis of having end stage renal disease, as described at § 406.13 of this chapter;
(4) Is not enrolled in any managed care plan (for example, Medicare Advantage, health care prepayment plans, or cost-based health maintenance organizations);
(5) Is not covered under a United Mine Workers of America health care plan; and
(6) Is in an episode.
(b) The episode is canceled in accordance with § 512.630(e) if at any time during the episode a beneficiary no longer meets all of the criteria in paragraph (a) of this section.
Collected 2026-10-30T05:54:32Z. Source file · JSON