[Federal Register: September 16, 2005 (Volume 70, Number 179)]
[Notices]
[Page 54751-54752]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr16se05-118]
[[Page 54751]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5017-N]
Medicare Program; Medicare Health Care Quality (MHCQ)
Demonstration Programs
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice informs eligible health care groups of an
opportunity to apply to participate in the Medicare Health Care Quality
demonstration. The goal of the demonstration is to improve the quality
of care and services delivered to Medicare beneficiaries through a
major system redesign that fosters best practice guideline usage,
continuous quality and patient safety improvement, shared decision
making between providers and patients, and the delivery of culturally
and ethnically appropriate care. This notice contains information on
how to obtain the complete solicitation and supporting information.
A competitive process will be used to select 8 to 12 health care
organizations (that is, physician group practices, integrated delivery
systems, and regional coalitions of physician group practices and
integrated delivery systems) to participate in the 5-year
demonstration. The application solicitation will be conducted in two
phases.
DATES: For the initial solicitation, applications will be considered if
received at the appropriate address, provided in the ADDRESSES section,
no later than 5 p.m. e.s.t., on January 30, 2006. For the second
solicitation phase, applications will be considered if we receive them
no later than 5 p.m. e.d.t., on September 29, 2006. Applicants
intending to submit a proposal for the second phase review should
forward a letter of intent to the same address listed in the ADDRESSES
section of this notice, no later than January 30, 2006.
Letter of Intent Requirements: The letter of intent should include the
following:
An outline of the demonstration proposal.
A description of the proposed organizational structure.
A timeline for development and implementation of the
proposed model.
A projected or desired date for submission of the
application.
This will enable us to--
1. Better plan for the second phase of the solicitation;
2. Keep prospective applicants apprised of any new developments
over the course of the solicitation process; and
3. Ensure that they have the latest information for preparing their
applications.
ADDRESSES: Mail or deliver applications to the following address:
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
mma646@cms.hhs.gov. Interested parties can obtain complete solicitation
and supporting information on the CMS Web site at http://www.cms.hhs.gov/researchers/demos/mma646/.
Paper copies can be obtained
by writing to Cynthia Mason at the address listed in the ADDRESSES
section of this notice.
SUPPLEMENTARY INFORMATION:
I. Background
Section 646 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173) amends title XVIII
(42 U.S.C. 1395 et seq.) of the Social Security Act (the Act) by
establishing the Medicare Health Care Quality (MHCQ) Demonstration
Programs. The MHCQ demonstration will test major changes to improve
quality of care while increasing efficiency across an entire health
care system. Broadly stated, the goals of the Medicare Health Care
Quality demonstration are to--
Improve patient safety;
Enhance quality;
Increase efficiency; and
Reduce scientific uncertainty and the unwarranted
variation in medical practice that results in both lower quality and
higher costs.
The legislation anticipates that we can facilitate these
overarching goals by providing incentives for system redesigns built on
adoption and use of decision support tools by physicians and their
patients, such as evidence-based medicine guidelines, best practice
guidelines, and shared decision-making programs; reform of payment
methodologies; measurement of outcomes; and enhanced cultural
competence in the delivery of care.
II. Provisions of This Notice
The MHCQ demonstration will test the ability of health care groups
to implement major system changes that reallocate resources to improve
quality and reduce costs of Medicare Parts A, B, and C. Each proposal
is expected to address all of the Institute of Medicine's ``Six Aims
for Improvement.'' The proposed system redesign should:
Include steps to improve patient safety in the delivery of
care,
Increase the effectiveness of the health care delivered,
minimizing the over- and under-utilization of services Through the use
of best practice guidelines and other measures,
Prioritize patient-centeredness in the delivery of care
with primary focus on patients' needs and comfort, Including increased
emphasis on patient education and development of self-care skills,
Improve the timeliness of care, significantly reducing
delay in the delivery of needed health care services,
Emphasize ways of improving efficiency in care delivery
and thus improving quality, and
Assure equity of care for all persons.
Further, we are persuaded that such system redesign should include the
integration of health information technology consistent with the
national health information infrastructure strategy and that--
Informs clinical practice;
Interconnects clinicians;
Personalizes health care; and
Improves population health.
We intend to use this demonstration to identify, develop, test, and
disseminate major and multi-faceted improvements to the entire health
care system. The focus will be on redesign projects that ``bundle''
multiple delivery improvements so as to introduce ``system-ness''
across the spectrum of care delivery--changes across and even between
organizations. The redesign must make the system patient-focused and
must undo the effects of a payment methodology that systematically
fragments care while encouraging both omissions and duplication of
care. At its ``grandest,'' particularly if a demonstration project is
conducted by a regional coalition and entails the participation of
other payers besides Medicare, this demonstration affords us and the
awardees an opportunity to reinvent the health care delivery system.
In keeping with our view that this demonstration authority is
intended to test models of basic health care system redesign, including
payment reform, we note that the statute provides broad authority for
us to waive both payment and non-payment provisions of the Medicare
program. Therefore, we are
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not specifying particular models of health care systems that
demonstration applicants must propose and test, but are looking to
applicants to specify the models they believe they can successfully put
into practice for the patients they serve in their communities.
As provided by applicable Federal statute, physician groups,
integrated delivery systems, and organizations representing regional
coalitions of physician groups or integrated delivery systems are
eligible to apply. Integrated delivery systems must include a full
range of health care providers including hospitals, clinics, home
health agencies, ambulatory surgery centers, skilled nursing
facilities, rehabilitation facilities and clinics, and employed,
independent or contracted physicians. Eligible organizations and
coalitions may form a new corporate entity for the purpose of
representing provider organizations or eligible organizations may
designate an existing entity as their representative. However, the
entity organizing the coalition and developing the demonstration
proposal must be an eligible provider organization.
Payments under the MHCQ demonstration will be made for services
furnished to Medicare beneficiaries and will be tied to cost savings,
as well as improvements in process and outcome measures, increases in
efficiencies, and reductions in costs in the targeted population
compared to a similar group or sample. Eligible organizations may
propose a variety of payment methodologies as long as those
methodologies are amenable to an evaluation methodology based upon
Medicare claims data. In addition, all proposals must assure budget
neutrality and no duplication of payments for existing Medicare
benefits. We will not be providing funding for start-up or other costs.
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
July 31, 2006.
Authority: Section 646 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA).
(Catalog of Federal Domestic Assistance Program; No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: May 19, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-18144 Filed 9-9-05; 8:45 am]
BILLING CODE 4120-01-P