I 

114TH CONGRESS 

2D SESSION H. R. 4848 

To delay and suspend implementation of a comprehensive care for joint 

replacement (CJR) payment model for episode-based payment for lower 

extremity joint replacement (LEJR) under the Medicare program in 

a budget neutral manner. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 23, 2016 

Mr. TOM PRICE of Georgia (for himself and Mr. DAVID SCOTT of Georgia) 

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and 

Means, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To delay and suspend implementation of a comprehensive 

care for joint replacement (CJR) payment model for 

episode-based payment for lower extremity joint replacement (LEJR) under the Medicare program in a budget 

neutral manner. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Healthy Inpatient Pro5 cedures Act of 2016’’ or the ‘‘HIP Act’’. 


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•HR 4848 IH

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Patient choice has a uniquely positive influ4 ence in achieving quality, responsiveness, effective5 ness, and efficiency of health care services. 

6 (2) The implementation of a Medicare payment 

7 model for comprehensive care for joint replacement 

8 (CJR) represents a significant change to the health 

9 care delivery system which could have a negative im10 pact on patient choice, access, and quality. 

11 (3) Patients with higher-cost complex surgeries 

12 (such as hip fractures and ankle replacement proce13 dures) or who suffer from multiple chronic condi14 tions may especially be at risk in the implementation 

15 of that model. 

16 (4) The implementation of that model begin17 ning April 1, 2016, provides physicians, hospitals, 

18 and post-acute providers with inadequate time to 

19 prepare for this abrupt shift in payment for these 

20 high-volume procedures and the changes in care de21 livery that they require. 


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•HR 4848 IH

1 SEC. 3. DELAY AND SUSPENSION OF IMPLEMENTATION OF 

2 A COMPREHENSIVE CARE FOR JOINT RE3 PLACEMENT (CJR) MEDICARE PAYMENT 

4 MODEL FOR LOWER EXTREMITY JOINT RE5 PLACEMENT (LEJR) IN A BUDGET NEUTRAL 

6 MANNER. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services shall not implement (and shall suspend 

9 any further implementation of) before January 1, 2018, 

10 the testing of a Comprehensive Care for Joint Replace11 ment Model (CJR) (described in the rule published in the 

12 Federal Register on November 24, 2015 (80 Fed. Reg. 

13 73274–73554)) to be conducted under section 1115A of 

14 the Social Security Act (42 U.S.C. 1315a) as an episode15 based payment model for lower extremity joint replace16 ment (LEJR). This section shall not apply to implementa17 tion of such model that has occurred before the date of 

18 the enactment of this Act. 

19 (b) CONSTRUCTION.—Nothing in this section shall be 

20 construed to affect the authority of the Secretary to re21 quire the participation of providers of services, suppliers, 

22 and beneficiaries in the testing or expansion of any other 

23 innovative payment and service delivery model under sec24 tion 1115A of the Social Security Act (42 U.S.C. 1315a). 

25 (c) OFFSETTING ADDITIONAL EXPENDITURES

26 THROUGH REDUCTIONS IN AMOUNTS APPROPRIATED TO


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1 THE PREVENTION AND PUBLIC HEALTH TRUST FUND.— 

2 Notwithstanding any other provision of law, the amount 

3 otherwise appropriated to the Prevention and Public 

4 Health Trust Fund under section 4002(b) of the Public 

5 Health Service Act (42 U.S.C. 300u–11(b))— 

6 (1) for fiscal year 2017 is reduced (and re7 scinded) by $180,000,000 (or $185,000,000 if this 

8 Act is enacted before July 1, 2016); and 

9 (2) for fiscal year 2018 is reduced (and re10 scinded) by $50,000,000. 

Æ 


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