[Federal Register: June 24, 2005 (Volume 70, Number 121)]
[Notices]
[Page 36613-36615]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr24jn05-81]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5022-N]
Medicare Program; Solicitation for Applications for the Medical
Adult Day-Care Services Demonstration
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice for solicitation of applications.
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SUMMARY: This notice informs interested parties of an opportunity to
apply for participation in the Medical Adult Day-Care Services
Demonstration. This demonstration tests an alternative approach to
service delivery by allowing home health beneficiaries to receive a
portion of the medical services included in their home health plan of
care in a medical adult day-care facility (MADCF). The project will
allow us to test potential improvements in quality
[[Page 36614]]
of care, outcomes, and program efficiency related to the provision of
home health services in an MADCF setting. We intend to use a
competitive application process to select up to five sites to
participate in this demonstration. This demonstration is restricted to
the States that license or certify medical adult day-care facilities.
FOR FURTHER INFORMATION AND TO OBTAIN A COPY OF THE SOLICITATION:
Interested parties can obtain complete solicitation submission
requirements and supporting information about this demonstration at the
Medical Adult Day-Care Services Demonstration webpage found at the
following Web site address: http://www.cms.hhs.gov/researchers/demos/MADCS/default.asp
.
Or by contacting: Armen Thoumaian, Ph.D., Mail Stop: S3-02-01,
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244. Phone: (410) 786-6672 or toll free at (877)
267-2323, Ext. 66672. E-mail address: AThoumaian@cms.hhs.gov.
DATES: Effective Date: Applications must be received by September 22,
2005.
ADDRESSES: Mail applications to--Centers for Medicare & Medicaid
Services, Attention: Dr. Armen Thoumaian, Mail Stop: S3-02-01, 7500
Security Boulevard, Baltimore, Maryland 21244. Because of staff and
resource limitations, we cannot accept applications by facsimile (FAX)
transmission or by e-mail. Applicants will receive a communication
acknowledging the receipt of their application.
SUPPLEMENTARY INFORMATION:
I. Background
Section 703 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA)(Pub. L. 108-173, enacted on December 8,
2003) requires that the Secretary shall establish a demonstration
project under which the Secretary shall, as part of a plan of care for
home health services established for a Medicare beneficiary by a
physician, permit a home health agency (HHA), directly or under
arrangements with a medical adult day-care facility (MADCF), to provide
medical adult day-care services as a substitute for a portion of home
health services that would otherwise be provided in the beneficiary's
home. Participation in the demonstration by Medicare beneficiaries
admitted for home health care is voluntary. The demonstration is
limited to not more than five sites and associated MADCF(s). Each site
may include all States in which it provides home health services as
long as the adult day-care services are provided in MADCFs licensed or
certified in one of the States that license or certify medical adult
day care facilities. Treatment under the 3-year demonstration is
limited across all sites to 15,000 beneficiaries at any one time. For
those Medicare beneficiaries who agree to participate in the
demonstration, the HHA will receive 95 percent of the prospective
payment system (PPS) amount that otherwise would have been paid for the
home health episode of care had all services been delivered in the
beneficiary's home.
The purpose of this demonstration is to evaluate the outcomes and
costs of providing innovative models of health care that include both
home health care services and medical adult day-care services that
improve the quality of life for Medicare beneficiaries. An independent
evaluation will be conducted for this demonstration. At the conclusion
of the demonstration, the Secretary must report to the Congress an
evaluation of the clinical and cost-effectiveness of the demonstration
as well as recommendations for the extension or termination of the
project.
II. Purpose
This notice solicits applications for a demonstration project in
which Medicare-certified HHAs, in partnership with a medical adult day-
care facility (MADCF), or facilities, provide medical adult day-care
services as a substitute for a portion of home health care services
that would otherwise be provided in the beneficiary's home. The
demonstration is initiated to determine whether these provisions will
result in higher quality care with better utilization of Medicare-
covered services while promoting the physical and mental health of
participating Medicare beneficiaries. The Medical Adult Day-Care
Services Demonstration will allow a home health agency (directly or in
conjunction with adult day health facilities) to provide a portion of
the services included in the home health plan of care in a MADCF
setting rather than in the beneficiary's home. As such, the
demonstration will allow us to gather data on the efficacy and cost-
effectiveness of providing those services in the adult day health
setting as an alternative to the home. Additional important outcomes
from this demonstration project include: measuring impacts on the
amounts and types of home health and other Medicare services
beneficiaries receive and settings in which they receive them;
utilization of other (non-Medicare covered) adult day health center
services; beneficiary health, function, and satisfaction; family/
caregiver satisfaction; beneficiary out of pocket cost and total
program costs; and HHA and MADCF financial outcomes. Most importantly,
we can learn whether beneficiaries are willing to receive part of their
home health services at an MADCF.
III. Site Selection
Section 703 of the MMA provides that the Secretary shall conduct a
three-year demonstration project in not more than five sites in States
that license or certify providers of services that furnish medical
adult day-care services. Potential sites are restricted to these
states. The following 36 states have been identified as meeting this
requirement: AK, AZ, CA, CO, DE, FL, HI, IA, KS, KY, LA, MA, ME, MD,
MN, MO, MT, NE, NH, NJ, NV, NM, NC, NY, OK, PA, RI, SC, TN, TX, UT, VA,
VT, WI, WV, WY. Applicants from states not listed must provide evidence
that the state licenses or certifies providers of services that furnish
medical adult day-care services.
A demonstration site is defined as a single HHA or a corporate
entity that includes one or more HHAs providing services in one or more
of the eligible States. Pursuant to section 703(f) of the MMA,
preference will be given to those agencies that are currently licensed
or certified through common ownership and control to furnish medical
adult day-care services according. We will require that all sites
selected to participate in the demonstration be associated through
ownership or through contractual agreement with one or more MADCFs.
Sites will be selected based on the proposals that clearly and most
convincingly address the issues set forth in the solicitation on our
Web site: http://www.cms.hhs.gov/researchers/demos/MADCS/default.asp.
Under the demonstration, the HHAs will be permitted to deliver (or
contract for the delivery of) medical adult day-care services as a
substitute for a portion of a beneficiary's home health care services
at an affiliated MADCF that has been State licensed or certified for at
least 2 years.
IV. Beneficiary Eligibility and Enrollment
The demonstration will be open to all Medicare beneficiaries that
meet the Medicare eligibility requirements for receiving home health
care services through the Medicare fee-for-service program.
Participation by Medicare beneficiaries in the demonstration is
voluntary. Participating HHAs will
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conduct patient assessments and other required activities as they
normally would under the Medicare conditions of participation except
that they would be able to offer Medicare home health patients the
opportunity to receive a portion of their care in a MADCF. During the
initial and follow-up patient assessments, HHAs will have the
opportunity to identify beneficiaries who might benefit from adult day-
care services. Demonstration participants are those beneficiaries who
agree to participate in the demonstration and receive part of their
home health services at the MADCF. Those who agree should also be
informed that they will be contacted in the future by the demonstration
support and evaluation contractor(s).
Participation by Medicare beneficiaries is completely voluntary and
participating beneficiaries have the option of withdrawing from
participation at any time. Up to 15,000 beneficiaries across the five
sites may participate in the demonstration at any given time. Sites
will be provided with enrollment limits proportional to their capacity
prorated against the combined total of 15,000 enrollees at any one
time. This will be done to ensure that smaller sites will have an
opportunity to enroll a fair portion of the total enrollment allowed
under the demonstration.
V. Payment
Under the demonstration, the participating HHAs will be paid 95
percent of the prospective payment system (PPS) amount that otherwise
would have been paid for the home health episode of care had all
services been delivered in the beneficiary's home. Current provisions
related to case-mix group assignment and payment adjustments are not
affected by the demonstration. Payment will be provided directly to the
HHA for all services delivered during the home health episode of care
whether provided at home or in the adult day health facility. Under
section 703(b)(1) of the MMA, the beneficiary may not be separately
charged for medical adult-day care services furnished as part of the
home health plan of care.
The statute requires the Secretary to monitor the demonstration to
ensure that the provision of services in the demonstration does not
result in a net increase in total spending, and provides the authority
to make payment adjustments to ensure that budget neutrality is
maintained.
VI. Collection of Information Requirements
The information collection requirements associated with this notice
are 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 July 31, 2006.
Authority: Section 703 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-173.
Dated: April 29, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-12524 Filed 6-23-05; 8:45 am]
BILLING CODE 4121-01-P