§ 512.630 Determination of the episode.
(a) Timing of episodes. Episodes initiated on or after January 1, 2028.
(b) Episode attribution. All items and services included in the episode are attributed to the CJR-X participant at which the anchor hospitalization or anchor procedure, as applicable, occurs.
(c) Episode initiation. An episode is initiated by—
(1) A beneficiary's admission to a CJR-X participant for an anchor hospitalization that is paid under a MS-DRG specified in § 512.625(a); or
(2) A beneficiary's receipt of an anchor procedure billed under a HCPCS code specified in § 512.625(a). If an anchor hospitalization is initiated on the same day as or within 3 days of an outpatient procedure for the same episode type at the same CJR-X participant, the episode start date will be that of the outpatient procedure rather than the admission date, and an anchor procedure will not be initiated.
(d) Episode conclusion. (1) An episode ends on the 90th day following the date of the anchor procedure or the date of discharge from the anchor hospitalization, as applicable, with the date of the anchor procedure or the date of discharge from the anchor hospitalization being counted as the first day in the 90-day post-discharge period.
(2) [Reserved]
(e) Cancellation of an episode. The episode is canceled and is not included in the reconciliation calculation as specified in § 512.650 if any of the following occur:
(1) The beneficiary ceases to meet any criterion listed in § 512.620.
(2) The beneficiary dies at any point during the episode.
(3) The episode qualifies for cancellation due to extreme and uncontrollable circumstances. An extreme and uncontrollable circumstance occurs if both of the following criteria are met:
(i) The CJR-X participant has a CCN primary address that—
(A) Is located in an emergency area, as those terms are defined in section 1135(g) of the Act, for which the Secretary has issued a waiver under section 1135; and
(B) Is located in a county, parish, or tribal government designated in a major disaster declaration under the Stafford Act.
(ii) The date of admission to the anchor hospitalization or the date of the anchor procedure is during an emergency period (as defined in section 1135(g) of the Act) or in the 30 days before the date that the emergency period (as defined in section 1135(g) of the Act) begins.
(4) The beneficiary is in a TEAM episode and receives a LEJR procedure at a CJR-X participant during the 30-day post-discharge period after a TEAM anchor hospitalization or TEAM anchor procedure.