Georgia Medicare TEAM Mandatory Bundle Model Guide 2026

The Transforming Episode Accountability Model, universally called TEAM, is the CMS Innovation Center's next-generation mandatory bundled payment model and the direct successor to both the Comprehensive Care for Joint Replacement (CJR) Model and Bundled Payments for Care Improvement Advanced (BPCI Advanced). TEAM launches January 1, 2026 in 188 randomly-selected Core-Based Statistical Areas (CBSAs) across the United States, holding participating acute care hospitals accountable for 30-day clinical episodes spanning five clinical categories. For Georgia hospitals, including those in the Atlanta-Sandy Springs-Roswell MSA that have operated under mandatory CJR since April 1, 2016, TEAM represents the next phase of mandatory bundled payment exposure and the centerpiece of CMMI's bundled payment strategy through 2030.

This guide explains how TEAM works, who participates, how Target Prices and reconciliation operate, what TEAM means for Georgia hospitals and beneficiaries, and how TEAM relates to its CJR and BPCI Advanced predecessors and to the broader CMMI portfolio.

By Brevy Care Team

The statutory and regulatory foundation

TEAM rests on a clear regulatory architecture:

• Section 1115A of the Social Security Act (42 U.S.C. § 1315a): the CMS Innovation Center statutory framework, added by ACA Section 3021 (Public Law 111-148, March 23, 2010). TEAM is a Section 1115A mandatory demonstration.
• TEAM Final Rule: published in the CY 2025 IPPS Final Rule at 89 FR 68986 on August 28, 2024. The final rule established TEAM's mandatory framework, CBSA selection methodology, episode definitions, three risk tracks, quality measures, and beneficiary protections.
• 42 CFR Part 512: TEAM implementing regulations. Part 512 codifies participant requirements, episode definitions, Target Price methodology, reconciliation rules, quality measurement, and health equity provisions.
• Section 1833(z) SSA: Advanced APM framework, applicable to Track 3 participation.
• MACRA 2015 (Public Law 114-10, April 16, 2015): Quality Payment Program framework.

TEAM's mandatory nature requires formal notice-and-comment rulemaking, similar to CJR (codified at 42 CFR Part 510) and distinct from voluntary CMMI demonstrations like BPCI Advanced.

The TEAM performance period

TEAM operates over five Performance Years:

• Performance Year 1: January 1, 2026 – December 31, 2026
• Performance Year 2: January 1, 2027 – December 31, 2027
• Performance Year 3: January 1, 2028 – December 31, 2028
• Performance Year 4: January 1, 2029 – December 31, 2029
• Performance Year 5: January 1, 2030 – December 31, 2030

TEAM sunsets December 31, 2030. Whether TEAM is extended or succeeded by another bundled payment model will depend on policy decisions in the late 2020s.

The five TEAM clinical episode categories

TEAM covers five clinical episode categories selected from the BPCI Advanced and CJR experience:

1. Lower Extremity Joint Replacement (LEJR)

• Direct successor to CJR's scope
• MS-DRG 469 (with MCC) and MS-DRG 470 (without MCC)
• Outpatient hip and knee replacement equivalents
• Total Hip Arthroplasty (THA), Total Knee Arthroplasty (TKA), bilateral, revision (selected)
• This is the highest-volume bundle for most hospitals

2. Surgical Hip/Femur Fracture Treatment (SHFFT)

• Emergency orthopedic procedures for hip fracture
• Higher-acuity than elective LEJR
• Distinct from elective hip replacement
• Often patients are frail elderly with multiple comorbidities

3. Spinal Fusion

• Neurosurgical/orthopedic procedures
• Cervical, thoracic, lumbar fusions
• High-cost variability across hospitals
• Significant post-acute care implications

4. Coronary Artery Bypass Graft (CABG)

• Major cardiac surgery
• High-cost episodes with substantial cardiac rehab and post-acute exposure
• Concentrated at select cardiac surgery centers

5. Major Bowel Procedure

• General surgical procedures (colectomy, etc.)
• Higher complication and readmission rates
• Variable post-acute care needs

The five-category scope is narrower than BPCI Advanced's 41 categories but broader than CJR's LEJR-only scope. The selection reflects CMMI's judgment that these are the highest-impact episodes with the strongest improvement potential.

The 30-day episode structure: a major change from CJR/BPCI Advanced

TEAM uses a 30-day episode beginning with anchor admission:

Episode start

• Anchor inpatient admission with a qualifying MS-DRG for one of the five categories
• (Or qualifying anchor outpatient procedure where applicable)

Episode end

• 30 days post-discharge (compared to CJR's 90 days and BPCI Advanced's 90 days)

What's included

• Anchor hospitalization
• Surgeon, anesthesia, hospital physician services
• Post-acute care (SNF, IRF, LTCH, home health) within the 30-day window
• Readmissions within 30 days
• Outpatient services within 30 days
• DME within 30 days

Why 30 days matters

The 30-day window is materially shorter than CJR's and BPCI Advanced's 90 days. This has substantial operational implications:

• Less post-acute spending in the bundle: most SNF stays and IRF stays continue past 30 days, but the bundle only captures the first 30 days
• Readmission window aligns with CMS's other 30-day measures (HRRP, etc.)
• Earlier reconciliation visibility: episode completes faster
• Reduced patient-level outlier risk: extreme outliers tied to long post-acute stays are partially capped by the window
• Different operational levers: focus shifts to discharge planning, immediate post-discharge transitions, and early readmission prevention

The 30-day duration is one of TEAM's most consequential design choices. Hospitals coming from a CJR/BPCI Advanced background must recalibrate their operational playbooks for a shorter window.

The three risk tracks

TEAM offers three risk tracks designed for different participant capacities, somewhat analogous to ACO REACH's risk progression:

Track 1: Lower-risk glide path

• Available in PY1 only (the first performance year, 2026)
• One-sided risk only: hospital can earn savings but cannot owe losses
• Designed to ease hospitals into mandatory participation
• Lower stop-gain (savings cap)
• Hospitals new to mandatory bundled payment can start here

Track 2: Standard two-sided

• Available throughout the model
• Two-sided risk: both earned savings and owed losses
• Stop-loss/stop-gain capped at moderate level (around 10%)
• The standard track for most hospitals
• Most CJR-experienced hospitals expected to choose Track 2 or Track 3

Track 3: Higher-risk Advanced APM

• Available throughout the model
• Two-sided risk with higher exposure (up to ~20%)
• Advanced APM eligible under Section 1833(z) SSA
• Hospitals with strong infrastructure and analytics
• Qualifies participating clinicians for QP determination (subject to threshold testing)

Track election

• Hospitals elect a track per performance year
• Track 1 only available PY1 (one-sided glide path)
• Hospitals can advance from Track 1 to Track 2 or Track 3 in later PYs

The Target Price methodology

TEAM's Target Price methodology continues the CJR tradition of blending hospital-specific baseline with regional benchmark:

Components

1. Hospital-specific historical baseline: historical episode spending at that hospital
2. Regional benchmark: regional average episode spending
3. Blend ratio: combination of hospital-specific and regional, designed to encourage convergence
4. Trend factor: annual update for cost growth
5. Discount factor: CMS's share, applied to the Target Price

Comparison to CJR

• CJR baseline was originally 67% hospital / 33% regional and shifted toward regional weighting over time
• TEAM's blend approach is similar but with different specific weights
• TEAM's discount may differ from CJR's 1.5%

Risk adjustment

• Patient-level risk adjustment for case-mix
• Beneficiary-level adjustment for medical complexity

Health equity ADI adjustment

• Beneficiary-level ADI (Area Deprivation Index) adjustment built into Target Price
• Higher ADI beneficiaries receive Target Price adjustment recognizing higher cost variability
• This is a significant change from CJR, which had no such ADI adjustment

Reconciliation methodology

TEAM reconciliation occurs annually:

Stop-loss/stop-gain by track

• Track 1 (PY1 only): stop-gain only (one-sided)
• Track 2: stop-loss/stop-gain ~10%
• Track 3: stop-loss/stop-gain ~20%

Quality adjustment

• Quality performance affects reconciliation
• Composite Quality Score (see below) determines retained savings share

NPRA-equivalent

• Actual spending vs. Target Price
• Positive = earned savings (capped per track stop-gain)
• Negative = owed losses (capped per track stop-loss; zero for Track 1)

The five TEAM quality measures

TEAM measures performance on five quality measures:

1. Hospital-Wide Risk-Standardized Readmission Rate: hospital-wide 30-day all-cause readmission, already collected for HRRP
2. CMS Patient Safety and Adverse Events Composite (PSI-90): hospital-wide patient safety composite, already collected for HACRP
3. Hybrid Hospital-Wide All-Cause Risk-Standardized Mortality: combined claims + clinical data mortality measure
4. THA/TKA Patient-Reported Outcomes (PRO): for hospitals performing LEJR; voluntary PRO submission similar to CJR
5. Medicare Spending Per Beneficiary (MSPB): hospital-wide efficiency measure

These measures are largely reused from existing CMS programs (HRRP, HACRP, IQR), reducing reporting burden compared to inventing new measures. The Composite Quality Score combines these measures with appropriate weighting.

Advanced APM status: Track 3 only

TEAM Track 3 qualifies as an Advanced APM under Section 1833(z) SSA. Tracks 1 and 2 are MIPS APMs but not Advanced APMs.

Track 3 Advanced APM requirements

1. CEHRT use
2. Quality measurement (TEAM quality measures)
3. Meaningful risk (Track 3 two-sided risk up to 20%)

Implications

• Hospitals in Track 3 can support QP determination for physicians (subject to APM Entity attribution rules)
• Tracks 1 and 2 do not directly support QP determination
• Most physicians achieve QP through MSSP/ACO REACH rather than TEAM tracks

Why hospitals might choose Track 3

• Higher upside potential
• Advanced APM benefits for hospital-employed physicians
• Aligns with hospitals' strategic value-based care plans

Why hospitals might choose Track 2

• Lower downside exposure
• Sufficient improvement opportunity at 10% cap
• Less infrastructure required

CBSA selection methodology

TEAM uses a stratified random selection of 188 CBSAs to ensure geographic diversity and representativeness. The selection methodology:

• Stratified by region (Census Division)
• Stratified by CBSA size (large MSA, smaller MSA, micropolitan)
• Stratified by health system characteristics
• Excluding Maryland (TCOC model already in place) and certain other special cases
• Excluding Native Hawaiian / Pacific Islander areas with separate models

The final rule lists the 188 selected CBSAs. Georgia CBSAs in the selection are subject to TEAM mandatory participation; Georgia CBSAs not selected are not.

Likely Georgia inclusions (subject to specific final rule list)

• Atlanta-Sandy Springs-Roswell, GA MSA: large MSA, high probability of selection given CJR participation
• Augusta-Richmond County, GA-SC MSA
• Savannah, GA MSA
• Macon-Bibb County, GA MSA
• Columbus, GA-AL MSA
• Athens-Clarke County, GA MSA
• Gainesville, GA MSA
• Other Georgia CBSAs

The specific list of selected CBSAs is in the TEAM Final Rule (89 FR 68986). Hospitals in any selected Georgia CBSA are mandatorily subject to TEAM.

Mandatory hospital participation

TEAM is mandatory for:

• Acute care hospitals paid under IPPS
• Located in selected CBSAs
• Meeting hospital characteristic criteria

Exemptions / exclusions

• Critical Access Hospitals (CAHs): not subject to TEAM
• Indian Health Service / tribal hospitals: generally excluded
• Psychiatric hospitals, rehab hospitals (IRFs), LTCHs: not IPPS hospitals
• Maryland hospitals: under separate TCOC model

Volume thresholds

• Hospitals must have sufficient episode volume to be subject to TEAM
• Low-volume hospitals may have limited or no participation

Coordination with concurrent models

TEAM coordinates with several concurrent and predecessor models:

CJR sunset

• CJR sunsets December 31, 2025, the same day TEAM launches January 1, 2026
• CJR participating hospitals (including Atlanta MSA hospitals) transition seamlessly to TEAM if their CBSA is selected
• LEJR continues as a covered episode under TEAM

BPCI Advanced sunset

• BPCI Advanced sunsets December 31, 2025
• BPCI Advanced clinical categories not in TEAM (cardiac valve, AMI, CHF, COPD, sepsis, stroke, pneumonia, etc.) lose CMMI bundled payment exposure unless picked up by other programs
• Some BPCI Advanced bundles map directly to TEAM (CABG, LEJR, SHFFT, Spinal Fusion, Major Bowel)

MSSP / ACO REACH attribution

• TEAM beneficiaries can also be aligned to MSSP or ACO REACH ACOs
• Attribution overlap rules apply
• TEAM episode spending counts toward ACO total cost of care

TEAM and HRRP

• Both measure 30-day readmissions
• TEAM readmissions are captured in the bundle reconciliation
• HRRP separately penalizes hospital-wide readmissions

TEAM and HACRP

• TEAM uses PSI-90 quality measure
• HACRP also uses PSI-90
• No double penalty, but both programs reference the same underlying measure

Health equity components

TEAM incorporates health equity in three significant ways:

1. Beneficiary-level ADI adjustment

• Area Deprivation Index (ADI) adjustment built into Target Price calculation
• Recognizes that higher-ADI beneficiaries have higher cost variability
• First mandatory CMMI model to include beneficiary-level ADI adjustment

2. Optional Health Equity Plan

• Hospitals can submit voluntary Health Equity Plan
• Identifies underserved populations and care gaps
• Outlines strategies to address disparities
• Not mandatory but encouraged

3. Decarbonization voluntary reporting

• Hospitals can voluntarily report environmental sustainability data
• Reflects HHS Climate and Health Strategy
• Recognizes healthcare's contribution to climate change

Georgia hospital implications

For Georgia hospitals, TEAM has several specific implications:

Atlanta MSA hospitals

• Continued mandatory bundled payment exposure
• Transition from 9-year CJR experience to TEAM design
• Operational playbooks need recalibration for 30-day window
• Five clinical categories vs. CJR's one: broader operational scope
• Three risk tracks: strategic choice required

Augusta, Savannah, Macon, Columbus, etc.

• If selected, mandatory participation for the first time
• Less operational experience with bundled payment (unless BPCI Advanced)
• Track 1 glide path available PY1 to ease transition
• Significant infrastructure investment needed

Non-selected Georgia CBSAs

• Not subject to TEAM
• Continue standard Medicare FFS for these episodes
• May voluntarily affiliate with TEAM-participating systems

System-wide strategic considerations

• Wellstar Health System: multiple hospitals across Atlanta MSA, deep CJR experience
• Emory Healthcare: Atlanta MSA hospitals, deep CJR experience, strong Advanced APM positioning
• Piedmont Healthcare: Atlanta MSA + statewide footprint, deep CJR experience
• Northside Hospital System: Atlanta MSA + expanded footprint, deep CJR experience
• Augusta University Health: Augusta MSA, CJR-experienced
• Grady Memorial Hospital: safety-net Atlanta MSA hospital, ADI adjustment relevant

14 best practices for TEAM participants

1. 30-day discharge planning intensity: TEAM's shorter window means discharge planning needs to start before admission for elective cases
2. Aggressive readmission prevention in days 1-30: 7-day follow-up, medication reconciliation, post-acute care coordination
3. SNF/IRF utilization optimization: particularly within the 30-day window
4. Home health rapid response: for elective cases, home discharge with home health is often optimal
5. Pre-operative optimization: same playbook as CJR: medical clearance, smoking cessation, anemia management
6. Track selection strategy: match track choice to hospital capacity and risk tolerance
7. Risk stratification: identify high-risk episodes for intensive case management
8. Five clinical pathways: develop standardized pathways for LEJR, SHFFT, Spinal Fusion, CABG, and Major Bowel
9. SHFFT-specific optimization: emergency orthopedic episodes need different operational design than elective LEJR
10. CABG bundle management: cardiac rehab and tight cardiology follow-up
11. Spinal Fusion management: pain management transition, PT coordination, post-discharge follow-up
12. Major Bowel optimization: surgical site infection prevention, nutrition support, readmission prevention
13. Health Equity Plan submission: voluntary but signals organizational commitment
14. Quality measure mastery: five measures spanning HRRP, HACRP, IQR concepts; leverage existing infrastructure

14 common TEAM transition issues

1. 30-day window underestimation: hospitals from 90-day CJR/BPCI Advanced may underweight readmissions at days 25-30
2. Track selection regret: choosing Track 1 in PY1 limits upside; choosing Track 3 too early risks downside losses
3. Five-category complexity: operationalizing five distinct clinical pathways is harder than CJR's one
4. SHFFT vs. LEJR confusion: these are distinct bundles with different operational profiles
5. CABG cardiology integration: for hospitals new to CABG bundles
6. Major Bowel surgical coordination: surgical oncology and colorectal coordination
7. Target Price calibration disputes: annual recalculation can produce unfavorable adjustments
8. ADI adjustment unfamiliarity: beneficiary-level ADI is new to most hospitals
9. Track 3 QP attribution complexity: physician QP determination through TEAM is nuanced
10. CJR-to-TEAM operational playbook gap: different episode duration requires playbook changes
11. BPCI Advanced bundles lost: bundles not in TEAM (cardiac valve, AMI, CHF, COPD, sepsis, etc.) lose CMMI exposure
12. Critical Access Hospital exclusion: CAHs in selected CBSAs are not subject (regional dynamics)
13. Health Equity Plan effort: voluntary but significant infrastructure to do well
14. Data lag in reconciliation: annual reconciliation occurs months after episodes complete

Six worked examples: Georgia Medicare beneficiaries under TEAM

1. Fulton 70: Atlanta TEAM LEJR

A 70-year-old Fulton County beneficiary undergoes elective total hip arthroplasty at Emory University Hospital Midtown in February 2026 (Performance Year 1). Atlanta-Sandy Springs-Roswell MSA is in the TEAM selection. Emory has elected Track 3 (Advanced APM eligible). The 30-day episode begins at admission and ends 30 days post-discharge. Emory's CJR-honed pathways translate well, with modest recalibration for the shorter window. Episode spending is reconciled against Target Price; quality performance modulates the savings/loss outcome.

2. DeKalb 75: DeKalb TEAM CABG

A 75-year-old DeKalb beneficiary undergoes CABG at a DeKalb cardiac surgery center in March 2026. The hospital has elected Track 2 (standard two-sided). The 30-day CABG episode includes anchor admission, ICU stay, cardiac surgery physician services, early cardiac rehabilitation, and any readmissions within 30 days. The hospital's cardiac surgery team coordinates with cardiac rehab and cardiology follow-up.

3. Cobb 68: Cobb TEAM SHFFT

A 68-year-old Cobb beneficiary suffers a hip fracture and is admitted to Wellstar Kennestone for surgical repair. SHFFT is one of TEAM's five categories. Unlike elective LEJR, this is an emergency episode: the beneficiary's comorbidities are higher and post-acute care needs more intensive. The 30-day window is dominated by post-acute SNF/IRF stay. Wellstar's CJR experience helps with operational design but SHFFT-specific pathways are still developing.

4. Worth County 72: Albany hospital (non-selected CBSA)

A 72-year-old Worth County beneficiary undergoes total knee arthroplasty at an Albany-area hospital. The Albany CBSA is not selected for TEAM (illustrative, the final rule list determines actual inclusion). The episode follows standard Medicare FFS without bundled payment accountability. Patient receives standard care.

5. Bibb 80: Macon TEAM

An 80-year-old Bibb beneficiary undergoes Major Bowel Procedure at a Macon hospital. Macon-Bibb County MSA is in the TEAM selection (illustrative). The hospital elected Track 1 (PY1 glide path). The 30-day episode includes anchor admission, surgical site infection prevention protocols, nutrition support, and readmission prevention. The hospital uses PY1 as a learning year before electing Track 2 or 3 in PY2.

6. Hall 67: Gainesville (Hall County, Atlanta MSA)

A 67-year-old Hall County beneficiary undergoes elective Spinal Fusion at a Gainesville hospital. Hall County is in the Atlanta-Sandy Springs-Roswell MSA. If the Atlanta MSA is selected for TEAM, the Gainesville hospital is subject to mandatory participation for all five categories including Spinal Fusion. The hospital develops or refines its spinal fusion clinical pathway.

Frequently Asked Questions

Contact resources

Federal Medicare resources

• Medicare (general): 1-800-MEDICARE (1-800-633-4227)
• CMS Innovation Center: innovation.cms.gov
• QPP Service Center: 1-866-288-8292
• Palmetto GBA (Part A/B MAC Jurisdiction J): 1-866-238-9650

Georgia state resources

• GeorgiaCares SHIP: 1-866-552-4464
• 211 Georgia: 2-1-1
• Georgia Department of Community Health: dch.georgia.gov
• Georgia Aging and Disability Resource Connection: 1-866-552-4464

Beneficiary advocacy

• Medicare Rights Center: 1-800-333-4114
• Eldercare Locator: 1-800-677-1116
• Atlanta Legal Aid: 404-377-0701
• Georgia Legal Services: 1-800-498-9469
• Acentra Health QIO: 1-844-455-8708

Federal benefit administration

• Social Security Administration: 1-800-772-1213
• Benefits Coordination & Recovery Center (BCRC): 1-855-798-2627

Provider/hospital resources

• Georgia Hospital Association: gha.org
• Medical Association of Georgia (MAG): mag.org
• NAACOS: naacos.com
• American Hospital Association: aha.org

Why TEAM matters

TEAM is the centerpiece of CMMI's bundled payment strategy through 2030, and the most consequential mandatory bundled payment model in Medicare history by virtue of its mandatory five-category design. By forcing hospitals in 188 selected CBSAs to operate under 30-day episode accountability across five clinical categories, TEAM extends the bundled payment experiment that began with CJR in 2016 into a new generation. The three-track structure mirrors ACO REACH's progressive risk design; the beneficiary-level ADI adjustment operationalizes CMMI's health equity strategy; and the 30-day episode duration recalibrates the operational frame from the 90-day windows of CJR and BPCI Advanced. For Georgia hospitals, particularly those in the Atlanta MSA that have nine years of CJR experience and those in other selected Georgia CBSAs that may face mandatory bundled payment for the first time, TEAM defines how Medicare will pay for these episodes through 2030. Whether the next mandatory bundle model in 2031 builds on TEAM or charts a new course, TEAM is the operational frame for the rest of this decade.

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