Federal regulations · Through 2026-10-28

42 CFR 512.622: Beneficiary notifications.

(a) CJR-X participant beneficiary notification—(1) Notification to beneficiaries. Each CJR-X participant must provide written notification to each CJR-X beneficiary of his or her inclusion in the CJR-X Model.
(2) Timing of notification. Prior to discharge from either the anchor hospitalization or the anchor procedure, as applicable, the CJR-X participant must provide the CJR-X beneficiary with a beneficiary notification as described in paragraph (a)(4) of this section.
(3) List of CJR-X beneficiaries who have received a notification. The CJR-X participant must be able to generate a list of all CJR-X beneficiaries who have received such notification, including the date on which the notification was provided to the CJR-X beneficiary, and provide such list to CMS or its designee upon request.
(4) Content of notification. The beneficiary notification must contain all of the following:
(i) A detailed explanation of CJR-X and how it might be expected to affect the CJR-X beneficiary's care.
(ii) That the CJR-X beneficiary retains freedom of choice to choose providers, suppliers, and services.
(iii) Explanation of how the CJR-X beneficiary can access care records and claims data through an available patient portal, if applicable, and how to share access to Blue Button® electronic health information with caregivers.
(iv) Explanation of the type of beneficiary-identifiable claims data the CJR-X participant may receive.
(v) A statement that all existing Medicare beneficiary protections continue to be available to the CJR-X beneficiary. These include the ability to report concerns of substandard care to Quality Improvement Organizations or the 1-800-MEDICARE helpline.
(vi) A list of the CJR-X collaborators with which the CJR-X participant has a sharing arrangement. This requirement may be fulfilled by the CJR-X participant including in the detailed notification a publicly available web address where the CJR-X beneficiary may access the list.
(b) CJR-X collaborator notice. The CJR-X participant must require every CJR-X collaborator that furnishes an item or service to a CJR-X beneficiary during an episode to provide written notice, to be developed by CMS, to the CJR-X beneficiary that describes general information on the quality and payment incentives under CJR-X, and the existence of the CJR-X collaborator's sharing arrangement.
(1) The notice must be provided no later than the time at which the CJR-X beneficiary first receives an item or service from the CJR-X collaborator during an episode. In circumstances where, due to the CJR-X beneficiary's condition, it is not feasible to provide notification at such time, the notification must be provided to the CJR-X beneficiary or his or her representative as soon as is reasonably practicable.
(2) The CJR-X collaborator must provide to CMS upon request, a list of all CJR-X beneficiaries who received such a notice, including the date on which the notice was provided to the CJR-X beneficiary.
(c) Discharge planning notice. The CJR-X participant must provide the CJR-X beneficiary with a written notice of any potential financial liability associated with non-covered items and services recommended or presented as an option as part of discharge planning, no later than the time that the CJR-X beneficiary discusses a particular post-acute care option or at the time the CJR-X beneficiary is discharged from an anchor procedure or anchor hospitalization, whichever occurs earlier.
(1) If the CJR-X participant knows or should have known that the CJR-X beneficiary is considering or has decided to receive a non-covered post-acute care service or other non-covered associated item or service, the CJR-X participant must notify the CJR-X beneficiary in writing that the item or service would not be covered by Medicare.
(2) If the CJR-X participant is discharging a CJR-X beneficiary to a SNF after an inpatient hospital stay, and the CJR-X beneficiary is being transferred to or is considering a SNF that would not qualify under the SNF 3-day waiver in § 512.695(b), the CJR-X participant must notify the CJR-X beneficiary in accordance with paragraph (b)(1) of this section that the CJR-X beneficiary will be responsible for payment for the items and services furnished by the SNF during that stay, except those items and services that would be covered by Medicare Part B during a non-covered inpatient SNF stay.
(d) Access to records and retention. The CJR-X participant must provide access to the list and notice described in paragraphs (a), (b), and (c), of this section to CMS, or its designees, in accordance with § 512.135.

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

(2) Timing of notification. Prior to discharge from either the anchor hospitalization or the anchor procedure, as applicable, the CJR-X participant must provide the CJR-X beneficiary with a beneficiary notification as described in paragraph (a)(4) of this section.

(3) List of CJR-X beneficiaries who have received a notification. The CJR-X participant must be able to generate a list of all CJR-X beneficiaries who have received such notification, including the date on which the notification was provided to the CJR-X beneficiary, and provide such list to CMS or its designee upon request.

(4) Content of notification. The beneficiary notification must contain all of the following:

(i) A detailed explanation of CJR-X and how it might be expected to affect the CJR-X beneficiary's care.

(ii) That the CJR-X beneficiary retains freedom of choice to choose providers, suppliers, and services.

(iii) Explanation of how the CJR-X beneficiary can access care records and claims data through an available patient portal, if applicable, and how to share access to Blue Button® electronic health information with caregivers.

(iv) Explanation of the type of beneficiary-identifiable claims data the CJR-X participant may receive.

(v) A statement that all existing Medicare beneficiary protections continue to be available to the CJR-X beneficiary. These include the ability to report concerns of substandard care to Quality Improvement Organizations or the 1-800-MEDICARE helpline.

(vi) A list of the CJR-X collaborators with which the CJR-X participant has a sharing arrangement. This requirement may be fulfilled by the CJR-X participant including in the detailed notification a publicly available web address where the CJR-X beneficiary may access the list.

(b) CJR-X collaborator notice. The CJR-X participant must require every CJR-X collaborator that furnishes an item or service to a CJR-X beneficiary during an episode to provide written notice, to be developed by CMS, to the CJR-X beneficiary that describes general information on the quality and payment incentives under CJR-X, and the existence of the CJR-X collaborator's sharing arrangement.

(1) The notice must be provided no later than the time at which the CJR-X beneficiary first receives an item or service from the CJR-X collaborator during an episode. In circumstances where, due to the CJR-X beneficiary's condition, it is not feasible to provide notification at such time, the notification must be provided to the CJR-X beneficiary or his or her representative as soon as is reasonably practicable.

(2) The CJR-X collaborator must provide to CMS upon request, a list of all CJR-X beneficiaries who received such a notice, including the date on which the notice was provided to the CJR-X beneficiary.

(c) Discharge planning notice. The CJR-X participant must provide the CJR-X beneficiary with a written notice of any potential financial liability associated with non-covered items and services recommended or presented as an option as part of discharge planning, no later than the time that the CJR-X beneficiary discusses a particular post-acute care option or at the time the CJR-X beneficiary is discharged from an anchor procedure or anchor hospitalization, whichever occurs earlier.

(1) If the CJR-X participant knows or should have known that the CJR-X beneficiary is considering or has decided to receive a non-covered post-acute care service or other non-covered associated item or service, the CJR-X participant must notify the CJR-X beneficiary in writing that the item or service would not be covered by Medicare.

(2) If the CJR-X participant is discharging a CJR-X beneficiary to a SNF after an inpatient hospital stay, and the CJR-X beneficiary is being transferred to or is considering a SNF that would not qualify under the SNF 3-day waiver in § 512.695(b), the CJR-X participant must notify the CJR-X beneficiary in accordance with paragraph (b)(1) of this section that the CJR-X beneficiary will be responsible for payment for the items and services furnished by the SNF during that stay, except those items and services that would be covered by Medicare Part B during a non-covered inpatient SNF stay.

(d) Access to records and retention. The CJR-X participant must provide access to the list and notice described in paragraphs (a), (b), and (c), of this section to CMS, or its designees, in accordance with § 512.135.

Collected 2026-10-30T05:54:32Z. Source file · JSON

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