# Medicare Program; Changes to the Comprehensive Care for Joint Replacement Payment Model (CJR): Extreme and Uncontrollable Circumstances Policy for the CJR Model
> **Centers for Medicare and Medicaid Services** · Final rule. · Published 2018-06-08 · Effective 2018-07-09 · 83 FR 26604
## Document
- **Document number:** 2018-12379
- **Category:** medicare
- **Sub-agency:** Centers for Medicare and Medicaid Services
- **Federal Register citation:** 83 FR 26604
- **CFR reference:** 42 CFR 510
- **Publication date:** 2018-06-08
- **Effective date:** 2018-07-09
- **HHS docket:** CMS-5524-F2
## Abstract

This final rule finalizes a policy that provides flexibility in the determination of episode spending for Comprehensive Care for Joint Replacement Payment Model (CJR) participant hospitals located in areas impacted by extreme and uncontrollable circumstances for performance years 3 through 5.

## Source
- [Federal Register document](https://www.federalregister.gov/documents/2018/06/08/2018-12379/medicare-program-changes-to-the-comprehensive-care-for-joint-replacement-payment-model-cjr-extreme)
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