[Federal Register: August 25, 2006 (Volume 71, Number 165)]
[Notices]
[Page 50428-50429]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr25au06-73]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5030-N]
Frontier Extended Stay Clinic Demonstration
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice informs interested parties of an opportunity to
apply for the Frontier Extended Stay Clinic (FESC) demonstration, which
is mandated by section 434 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003. A FESC is designed to
address the needs of seriously or critically ill or injured patients
who, due to adverse weather conditions or other reasons, cannot be
transferred to acute care hospitals, or patients who do not need a
hospital level of care but need monitoring and observation for limited
periods of time.
DATES: Applications will be considered timely if we receive them no
later than 5 p.m., Eastern Standard Time (e.s.t), on November 24, 2006.
ADDRESSES: Mail or deliver applications to the following address:
Centers for Medicare & Medicaid Services, Attention: Sid Mazumdar, Mail
Stop: C4-15-27, 7500 Security Boulevard, Baltimore, MD 21244,
Siddhartha.Mazumdar@cms.hhs.gov. Fax: 410-786-1048. Because of staff
and resource limitations, we cannot accept applications by facsimile
(fax) transmission or by e-mail.
FOR FURTHER INFORMATION CONTACT: Sid Mazumdar at (410) 786-6673.
Interested parties can obtain the complete application on the CMS Web
site at http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS061689.
Paper copies can be obtained by
writing to Sid Mazumdar at the address listed in the ADDRESSES section
of this notice.
SUPPLEMENTARY INFORMATION:
I. Background
We have previously developed alternative provider types designed to
make available basic acute care and emergency services in remote
geographic areas. In response to Congressional mandates, in 1991 we
piloted the Montana Medical Assistance Facility (MAF) Demonstration and
in 1993 implemented the Essential Access Community Hospital/Rural
Primary Care Hospital (EACH/RPCH) Program. These programs tested the
concept of a limited service hospital, including lower required levels
of physician and nurse staffing than full service hospitals. In the
Balanced Budget Act of 1997, Congress mandated a nationwide program
called ``Rural Hospital Flexibility Program'', the purpose of which is
the provision of needed acute care services by a new type of provider
type known as a ``critical access hospital'' (CAH). CAHs are entities
in rural areas that generally provide limited services.
Now under section 434 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA) the Congress
established ``The Frontier Extended Stay Clinic Demonstration
Project,'' to test the feasibility of providing extended stay services
to remote frontier areas under Medicare payment and regulations. In
remote frontier areas, weather and distance can prevent patients who
experience severe injury or illness from obtaining immediate transport
to an acute care hospital. In some instances, when patients are unable
to be transported, local clinics staffed by physicians or other health
professionals may offer observation services until the patient can be
transferred or is no longer in need of transport. This type of extended
stay service is not currently reimbursed by Medicare, Medicaid, or most
third-party payers. For several years, officials in the State of Alaska
and several state offices of Rural Health, Primary Care Offices, and
Primary Care Associations have explored the development of a new
provider type that would enable reimbursement of these services.
In designing the demonstration, the goal is to allow flexibility
for these remote clinics to serve the needs of a range of patients for
whom transportation to a full-service acute care hospital is
problematic. In addition, this demonstration also attempts to ensure
safety in clinics that have neither the institutional experience nor
the level of technological sophistication of hospitals. As authorized
by statute, we are defining requirements for providers to participate
in the Frontier Extended Stay Clinic (FESC) demonstration.
Specifically, section 434(a) of the MMA allows waiver of provisions
of the Medicare program as are necessary to conduct the demonstration
project, under which a FESC is treated as a provider of items and
services under the Medicare program. The FESC must be located in a
community which is-(1) at least 75 miles away from the nearest acute
care hospital, critical access hospital, or (2) is inaccessible by
public road. The distance requirement is in relation to the nearest
acute care or critical access hospital, regardless of whether patients
are generally transferred to that hospital. In addition, we are
determining mileage as measured in terms of the shortest distance by
road.
We believe the FESC should be designed to address the needs of
seriously or critically ill or injured patients who, due to adverse
weather conditions or other reasons, cannot be transferred to acute
care hospitals, or patients who do not meet CMS inpatient hospital
admission criteria and who need monitoring and observation for a
limited period of time. We believe that the FESC should provide
extended stay services under circumstances when weather and
transportation conditions prevent transfer, but apart from such
circumstances when a patient's condition warrants hospitalization, he
or she should be transported to an acute care hospital.
According to section 434(e) of the MMA, the FESC demonstration will
last for three years. Unless reauthorized, at the end of this period,
the FESCs will lose their certification as Medicare providers.
Moreover, pursuant to section 434(d)(2) of the MMA, the demonstration
is to be budget neutral.
II. Provisions of the Notice
A. Eligible Organizations
Potentially qualifying applicants are currently operational primary
care clinics, including clinics operated by the Indian Health Service
or tribal authorities. Other clinics may be eligible
[[Page 50429]]
if they propose plans to adopt the features of a FESC. To be eligible
for the Frontier Extended Stay Clinic demonstration, a clinic must be
located in a community which is at least 75 miles from the nearest
acute care hospital or critical access hospital, or which is
inaccessible by public road. Mileage is measured in terms of the
shortest distance by road.
B. Conditions of Participation
This notice solicits applications for demonstration projects to
enable participating remote clinics to provide services to seriously or
critically ill or injured patients who, due to adverse weather
conditions, or other reasons, cannot be transferred quickly to an acute
care hospital, and to patients who do not meet hospital admission
criteria but who need monitoring and observation for a limited period
of time.
FESCs may vary as far as their architectural design and original
type of clinic. At a minimum, an interested clinic must be able to
provide primary care, ambulatory care, and extended stay services, but
there are no requirements that an interested clinic be of any
particular type. For example, Rural Health Clinics (RHCs) and federally
qualified health centers (FQHCs), which are separately certified under
Medicare, are especially appropriate for the FESC model. We will
require each such clinic to explain how its staff and equipment will
meet the needs of emergency and overnight patients.
Given the wide variety of clinical conditions that a clinic will
face, it is vital that each FESC maintain stable, effective transfer
relationships with acute care hospitals. All clinics participating in
the FESC demonstration will be required to keep all billable items
under the demonstration separate from those of the existing outpatient
clinic. The FESC portion of a clinic participating in the demonstration
will be able to share staff and resources with its non-FESC portion as
long as billing for staff and resources is kept distinct during
discrete blocks of time. An applicant must also describe its transfer
agreements with acute care hospitals.
In addition, we expect all participants in the demonstration to
have a physically separate area dedicated to extended stay FESC
patients. A more specific listing of the FESC requirements are found in
the application package at Web address identified above.
C. Evaluation Process and Criteria
If the application meets the basic eligibility requirements and
responds to all components of the application, it will be referred to a
technical review panel for evaluation and scoring for an independent
review. The comments and evaluations of the panelists will be
transcribed into a summary statement that will serve as the basis for
award decisions. The evaluations of the panelists will contain
numerical ratings based on the rating criteria specified in this
section, the ranking of all applications, and a written assessment of
each application. In addition, we will conduct a financial analysis of
the recommended proposals and evaluate the proposed projects to ensure
that they are budget neutral. CMS will make the final selection.
The evaluation criteria and weights are detailed in the complete
application package. These criteria will be used to evaluate the
applications for the FESC demonstration. Applications will be scored on
an absolute basis. The application package, as well as the Medicare
Waiver Demonstration Application, are available on the CMS Web site.
III. Requirements for Submission of Applications
Individual clinics or consortia that represent several clinics may
submit applications. Each applicant organization is to submit one
application, regardless of the number of proposed demonstration sites.
The application is to be coordinated and submitted by an organizational
component that has the authority to determine the financial and
clinical service policy of an applicant body. If applicable, variations
related to proposed sites should be outlined in the application text or
supplemental materials. Applications should be a maximum of 40
typewritten pages, excluding appendices. The complete application
package is at the CMS Web site at http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS061689.
Hard copies
In order to be considered for review by the technical review panel,
applicants must complete, sign, date and return the Medicare Waiver
Demonstration Applicant Data Sheet found on this Web page. The Medicare
Waiver Demonstration Application, on the Web page, serves as the
required outline for submitting information in the application. The
required narrative portion is to consist of responses to the questions
under ``Evaluation Process and Criteria.'' Queries for the narrative
portion of the application may be submitted in writing by mail, fax, or
e-mail. (Please see the ADDRESSES section of this notice for necessary
information.)
IV. 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 434 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 Pub. L. 108-173.
Dated: May 18, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E6-14176 Filed 8-24-06; 8:45 am]
BILLING CODE 4120-01-P