Participants
Which Hospitals Must Participate In CJR-X?
CJR-X is mandatory for most acute-care hospitals paid under both Medicare’s Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS).
CMS created limited exclusions for TEAM participants, Maryland hospitals, and facilities outside both payment systems. Participation and financial reconciliation are separate questions: a hospital can remain a participant even when low procedure volume limits reconciliation.
Hospitals Required to Participate
The model applies nationwide to acute-care hospitals that receive payment under both IPPS and OPPS. CMS identifies the hospital as the participant and accountable entity, even when physicians, rehabilitation providers, home health agencies, and other partners furnish care during the episode.
Key Exclusions
TEAM Participants
Hospitals participating in TEAM are excluded from CJR-X until TEAM ends. Eligible hospitals are then required to enter CJR-X.
Maryland Hospitals
Maryland acute-care hospitals are excluded because they operate under the state's distinct Medicare payment model.
CAHs and Rural Emergency Hospitals
These facilities are exempt because they are not paid under both IPPS and OPPS.
Other Payment-System Exclusions
Hospitals not paid under both prospective payment systems do not meet the model's participation criteria.
Participation vs Financial Reconciliation
Hospitals must prepare for model requirements even when their lower-extremity joint replacement volume is low. Under the final rule, a hospital must reach the applicable episode-volume threshold before payment reconciliation applies for a performance year. Leaders should not treat low historical volume as a permanent exemption: service-line shifts, outpatient migration, and annual volume changes can alter financial exposure.
Common Eligibility Questions
Is CJR-X mandatory?
Yes. CJR-X is mandatory nationwide for most eligible acute-care hospitals paid under both the Inpatient Prospective Payment System and Outpatient Prospective Payment System beginning January 1, 2028.
Are TEAM hospitals required to participate in CJR-X?
No. Hospitals participating in TEAM are excluded from CJR-X while TEAM is active. When TEAM ends after December 31, 2030, otherwise eligible hospitals move into CJR-X.
Are rural hospitals exempt from CJR-X?
Not automatically. Critical Access Hospitals and Rural Emergency Hospitals are exempt because they are not paid under both IPPS and OPPS. Other rural, Medicare-dependent, and Sole Community Hospitals may participate but receive 5% stop-loss protection.
Last reviewed: August 16, 2026 Primary source: CMS CJR-X Model (cms.gov)