Tuesday, March 21, 2017 Startup of Cardiac Bundling Program, CJR Expansion, Delayed Until at Least October 1 The introduction of a mandatory Medicare bundling program for cardiac care scheduled for a July 1 rollout is now on hold until October—and possibly until 2018, according to a new interim final rule issued by the US Department of Health and Human Services (HHS). The delay also postpones the expansion of an existing bundling program for hip and knee replacements until the same date. The initial final rule requires 98 randomly selected metropolitan areas to participate in bundling programs for care associated with bypass surgery and heart attacks under Medicare parts A and B, and includes provisions that will incentivize the use of cardiac rehabilitation. The 2017 rule also includes an expansion of the Comprehensive Care for Joint Replacement (CJR) model beyond hip and knee arthroplasty, to include patients undergoing care for hip and femur fractures. Some portions of the rule were scheduled to be implemented on February 18 of this year but were delayed when, in late January, the Trump administration froze the implementation of new rules for 60 days. HHS then moved the implementation of these rules back to March 21. Now, those portions of the rule won't be put into place until May 20. But those elements are what Modern Healthcare described as "minor changes." The big issue—the actual launch of the new and expanded bundling programs themselves—has been put on hold until at least October 1, with HHS now seeking comment on the "appropriateness" of not only that delay but the possibility of putting off implementation until early 2018. "This additional 3-month delay [from July to October] is necessary to allow time for additional review, to ensure that the agency has adequate time to undertake notice and comment rulemaking to modify the policy if modifications are warranted, and to ensure that in such a case participants have a clear understanding of the governing rules and are not required to take needless compliance steps due to the rule taking effect for a short duration before any potential modifications are effectuated," the new interim rule states. APTA's education efforts on bundling began well before the April 1, 2016, startup of CJR and include 2 webinars (1 on the basics of the CJR program and 1 that includes insights from PTs participating in bundled care programs), an article in PT in Motion magazine, and a webpage that contains background information as well as links to evidence-based clinical information and community programs.