{"data":{"id":"us/42-cfr-512.620","jurisdiction":"us","citation":"42 CFR 512.620","heading":"Beneficiary inclusion criteria.","body":"(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—\n(1) Is enrolled in Medicare Parts A and B;\n(2) Has Medicare as their primary payer;\n(3) Is not eligible for Medicare on the basis of having end stage renal disease, as described at § 406.13 of this chapter;\n(4) Is not enrolled in any managed care plan (for example, Medicare Advantage, health care prepayment plans, or cost-based health maintenance organizations);\n(5) Is not covered under a United Mine Workers of America health care plan; and\n(6) Is in an episode.\n(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.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 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"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-10-28/title-42.xml","current_through":"2026-10-28","vintage":"","retrieved_at":"2026-10-30T05:54:32Z","sha256":"4506cc3fbb6b561163a90736ae9e9e914763ebfa79a240816e0cf481ecf43d8b","source_id":"us-cfr","stale":false,"prev":"us/42-cfr-512.615","next":"us/42-cfr-512.622"},"notice":"GroundRules: Original legal text. Not legal advice."}