[Federal Register: October 6, 2004 (Volume 69, Number 193)]
[Notices]
[Page 59929-59930]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr06oc04-91]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5015-N]
Medicare Program; Care Management for High-Cost Beneficiaries
(CMHCB) Demonstration
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice informs eligible health care organizations of an
opportunity to apply to implement and operate a care management
demonstration serving high-cost beneficiaries in the original Medicare
fee-for-service (FFS) program. This voluntary demonstration is part of
an effort to develop and test multiple strategies to improve the
coordination of Medicare services for high-cost FFS beneficiaries. The
notice contains information on how to obtain the complete solicitation
and supporting information.
DATES: Applications will be considered timely if we receive them on or
before January 4, 2005.
ADDRESSES: Mail applications to--Centers for Medicare & Medicaid
Services, Attention: Cynthia Mason, Mail Stop: C4-17-27, 7500 Security
Boulevard, Baltimore, Maryland 21244.
Because of staff and resource limitations, we cannot accept
applications by facsimile (FAX) transmission or by e-mail.
FOR FURTHER INFORMATION CONTACT: Cynthia Mason at (410) 786-6680 or
cmhcbdemo@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Background
The Department of Health and Human Services is developing and
testing multiple strategies to improve the coordination of Medicare
services for beneficiaries with high-cost conditions. However, one
approach that remains to be studied is intensive management for high-
cost beneficiaries with various medical conditions to reduce cost as
well as improve quality of care and quality of life for those
beneficiaries. Therefore, we are interested in proposals to restructure
care or enhance the management of care for beneficiaries with costly
medical conditions. It is anticipated that organizations will serve
high-risk beneficiaries with a variety of medical conditions and that
the vast majority of beneficiaries participating in the demonstration
will have multiple conditions. One organization will be selected per
area to offer services to eligible beneficiaries. Beneficiary
participation in the programs will be voluntary and will not change the
amount, duration or scope of participants' fee-for-service (FFS)
Medicare benefits. FFS Medicare benefits will continue to be covered,
administered, and paid under the traditional Medicare FFS program.
Programs will be offered at no charge to the beneficiary. Organizations
chosen for the demonstration will not be able to restrict beneficiary
access to care (for example, there can be no utilization review or
gatekeeper function) or restrict beneficiaries to a limited number of
physicians in a network.
Applicants may propose to serve one or more areas, but their
proposed service areas must be adjusted to ensure that the population
is of an appropriate size that would ensure statistically significant
results. Also, to avoid any overlap between the current FFS care
management demonstrations or the Chronic Care Improvement Programs
(CCIP), it will be necessary to exclude from the Care Management for
High-Cost Beneficiaries (CMHCB) demonstration population any
[[Page 59930]]
beneficiaries who meet the criteria to participate in existing
demonstrations or CCIP.
Organizations may be paid a monthly fee per participant or
participate under a gain-sharing arrangement based on Medicare savings;
however, fee and gain-sharing payments will be contingent on
improvements in clinical quality of care, beneficiary and provider
satisfaction, and savings to Medicare in the intervention groups
compared to control groups.
II. Provisions of This Notice
This demonstration is intended to test models of care management
for high-cost beneficiaries under the Medicare FFS program,
incorporating relevant features from traditional disease management
programs, but allowing sufficient flexibility for us and the awardees
to adapt the design of CMHCB programs to meet the unique needs of the
high-cost Medicare population. For some beneficiaries with high-cost
conditions, the restructuring of the care management plan to integrate
provider services in the program and to deliver those services in non-
acute care locations such as the beneficiary's home could significantly
improve the beneficiary's quality of life while simultaneously reducing
costs. Under the CMHCB demonstration, we hope to test a variety of
models such as intensive case management, increased provider
availability, structured chronic care programs, restructured physician
practices, and expanded flexibility in care settings to deliver care to
high-cost beneficiaries with multiple conditions.
The organization(s) that are awarded the demonstration project will
be required to agree to assume financial risk in the event of failure
to meet agreed upon performance guarantees for clinical quality,
beneficiary and provider satisfaction and savings targets. That
financial risk will include all fees and gain-sharing payments.
Organizations eligible to apply to implement and operate care
management programs under CMHCB include--
Physician groups;
Hospitals; or
Integrated delivery systems.
Other organizations may apply, but only as part of a consortium
that includes physician groups, hospitals, or integrated delivery
systems that would play a major role in the operation of the proposed
CMHCB demonstration. Eligible organizations must be capable of
providing ambulatory health care services.
We plan to make approximately four to six awards. Interested
parties can obtain complete solicitation and supporting information on
the CMS Web site at http://www.cms.hhs.gov/researchers/demos/cmhcb.asp.
Paper copies can be obtained by writing to Cynthia Mason at the address
listed in the ADDRESSES section of this notice.
III. Collection of Information Requirements
This information collection requirement is subject to the Paperwork
Reduction Act of 1995 (PRA); however, the collection is currently
approved under OMB control number 0938-0880 entitled ``Medicare
Demonstration Waiver Application'' with a current expiration date of 7/
31/2006.
Authority: Section 402(a)(1)(B) and (a)(2) of the Social
Security Amendments of 1967, Pub. L. 90-248, as amended, 42 U.S.C.
1395b-1(a)(1)(B) and (a)(2).
(Catalog of Federal Domestic Assistance No. 93.773 Medicare-Hospital
Insurance Program; and No. 93.774, Medicare--Supplementary Medical
Insurance Program)
Dated: September 15, 2004.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 04-22459 Filed 10-1-04; 4:00 pm]
BILLING CODE 4120-01-P