[Federal Register Volume 75, Number 141 (Friday, July 23, 2010)]
[Notices]
[Pages 43178-43180]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-18139]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5047-N]
Medicare Program; Solicitation for Proposals for the Medicare
Imaging Demonstration
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice informs interested parties (here in there after
referred to as conveners) of an opportunity to apply to participate in
the Medicare Imaging Demonstration (MID) that was authorized by section
135(b) of the Medicare Improvements for Patients and Providers Act of
2008 (MIPPA). The goal of the MID is to collect data regarding
physician compliance with appropriateness criteria selected by the
Secretary under the terms of the statute in order to determine the
appropriateness of advanced diagnostic imaging services furnished to
Medicare beneficiaries.
DATES: Proposals will be considered timely if they are received on or
before 5 p.m., Eastern Standard Time (E.S.T.) on September 21, 2010.
[[Page 43179]]
ADDRESSES: Proposals should be mailed to the following address: Centers
for Medicare & Medicaid Services, Attention: Linda R. Lebovic, 7500
Security Boulevard, Mail Stop: C4-17-27, Baltimore, Maryland 21244-
1850.
FOR FURTHER INFORMATION CONTACT: Linda R. Lebovic at (410) 786-3402 or
by e-mail at [email protected].
SUPPLEMENTARY INFORMATION:
General Information: Please refer to file code [CMS-5047-N] on the
application. Proposals (an unbound original and 3 copies plus an
electronic copy on CD-ROM) must be typed for clarity and should not
exceed 40 double-spaced pages, exclusive of cover letter, the executive
summary, resumes, forms, and supporting documentation. Because of
staffing and resource limitations, we cannot accept proposals by
facsimile (FAX) transmission. Applicants may, but are not required to,
submit a total of 10 copies to assure that each reviewer receives a
proposal in the manner intended by the applicant (for example,
collated, tabulated color copies). Hard copies and electronic copies
must be identical.
Eligible Organizations: CMS anticipates that a wide variety of
interested parties may be eligible to apply as conveners or in
collaboration with other organizations to perform the responsibilities
specified. Examples of conveners include, but are not limited to,
medical specialty societies, physician groups, integrated health care
delivery systems, independent practice associations, radiology benefit
managers, health plans, information technology vendors, and
collaborations among the above parties.
I. Provisions of This Notice
This notice informs interested parties (here in there after
referred to as conveners) of an opportunity to apply to participate in
the Medicare Imaging Demonstration (MID) that was authorized by section
135(b) of the Medicare Improvements for Patients and Providers Act of
2008 (MIPPA). The goal of the MID is to collect data regarding
physician compliance with appropriateness criteria selected by the
Secretary under the terms of the statute in order to determine the
appropriateness of advanced diagnostic imaging services furnished to
Medicare beneficiaries. The authorizing legislation allows the
Secretary to include in the demonstration advanced diagnostic imaging
services such as those defined in Sec. 1834(e)(1)(B) of the Social
Security Act (the Act): Diagnostic magnetic resonance imaging (MRI),
computed tomography (CT), nuclear medicine (including positron emission
tomography) and such other diagnostic imaging services, including
services described in Sec. 1848(b)(4)(B) of the Act (excluding X-ray,
ultrasound, and fluoroscopy), as specified by the Secretary in
consultation with physician specialty organizations and other
stakeholders. The law requires that the appropriateness criteria used
in the demonstration be based on those developed or endorsed by medical
specialty societies. The Centers for Medicare & Medicaid Services (CMS)
worked with medical specialty societies and other stakeholders,
including the AQA Alliance, to get their input and information on
available appropriateness criteria. For purposes of this demonstration,
the ``appropriateness criteria'' referenced in the statute will be
published medical specialty society guidelines relevant to the 11
procedures studied in the demonstration that are developed or endorsed
by relevant medical specialty societies, are consistent with the spirit
of section 135(b)(2)(B)(ii)(II), and which have been selected by the
Secretary under the terms of the statute. (We believe the
appropriateness criteria are the product of consensus and meet the
spirit of section 135(b)(2)(B)(ii)(II) of MIPPA. Consequently,
published medical specialty society guidelines relevant for the 11
procedures are included in the demonstration.
The law prohibits the use of prior authorization in the
demonstration. The design of the demonstration will permit evaluation
of the appropriateness of imaging services across a range of advanced
diagnostic imaging studies, geographic areas, demographic
characteristics and practice settings (such as private and academic
practices) in the Medicare fee-for-service program. CMS is seeking
participation by 2,500 to 3,500 physicians from 500 to 650 physician
practices that vary in size, specialty mix, type (academic and private
practice), and location (urban, rural, and suburban) to obtain
substantial sample size for the evaluation.
The demonstration will test whether the use of decision support
systems (DSSs) can improve quality of care and reduce unnecessary
radiation exposure and utilization by promoting appropriate ordering of
advanced diagnostic imaging services. Physician practices will receive
feedback on the degree of appropriateness relative to the specified
medical specialty society guidelines used under the demonstration.
CMS is seeking conveners that can provide a panel of participating
physician practices that agree to use an advanced diagnostic imaging
DSS for purposes of this demonstration. The Secretary has chosen to use
conveners as a vehicle to recruit physician practices for participation
in the demonstration because it is expected that the likely applicants
for the convener have well developed relationships (or the ability to
establish) with a significant network of physicians that could be
potential applicants for participation in the demonstration. Therefore,
conveners would be highly effective at providing a robust panel of
physicians that could satisfy the selection requirements outlined in
the statute. The convener will secure a DSS for advanced diagnostic
imaging services that will remain current with the medical specialty
society guidelines used under the demonstration, recruit physician
practices, and make the DSS available to physician practices
participating in the demonstration. Through the DSS, a convener will
collect data on physician ordering of the specified services and test
results, and provide feedback to physicians on ordering
appropriateness. The convener will also distribute payments (as
determined by CMS) to the participating practices for reporting data.
In this capacity, the convener will be responding to the solicitation
on its behalf as applicant. For the demonstration, interested parties
may need to collaborate as a convener in order to have a panel of
participating physician practices, the availability of the DSS for use
by the physician practices, and must comply with demonstration
requirements.
A competitive process will be used to select conveners. CMS
anticipates selecting up to six conveners to participate in the 2-year
demonstration. CMS is aware that certain arrangements under this
demonstration could raise possible fraud, waste, and abuse concerns,
including concerns under the anti-kickback statute and the physician
self-referral law. While CMS has the authority to waive the application
of certain fraud, waste, and abuse laws, it is anticipated that doing
so, if at all, will only occur after evaluating the provisions of the
proposals on a case-by-case basis and considering whether a waiver is
necessary to carry out the demonstration project.
Physician practices must apply through a convener and the
convener's application must include the criteria and rationale for
recruiting physician practices and obtaining their buy-in for the use
of the DSS. The Secretary has
[[Page 43180]]
chosen to use conveners as a vehicle to recruit physician practices for
participation in the demonstration because it is expected that the
likely applicants for the convener have well developed relationships
(or the ability to establish) with a significant network of physicians
that could be potential applicants for participation in the
demonstration. Therefore, conveners would be highly effective at
providing a robust panel of physicians that could satisfy the selection
requirements outlined in the statute. Conveners must also disclose in
the application whether the DSS may be retained by the participating
practice after the demonstration is concluded and whether the DSS may
be used to order items and services other than the subject imaging
services.
Applicants must submit their applications in the standard format
outlined in CMS' Medicare Waiver Demonstration Application and MID
solicitation in order to be considered for review by the technical
review panel. Applications not received in this format will not be
considered for review.
The Medicare Waiver Demonstration Application can be found
electronically at: http://www.cms.hhs.gov/cmsforms/downloads/cms10069.pdf.
For specific details regarding the MID, please refer to the
solicitation on the CMS Web site at: http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/Medicare_Imaging_Demonstration.pdf.
II. Collection of Information Requirements
Section 135(b)(4)(A) of the MIPPA (Pub. L. 110-275) exempts this
demonstration from the Chapter 35 of Title 44 of the United States
Code; however, the collection form entitled ``Medicare Demonstration
Waiver Application'' is currently approved under OMB control number
0938-0880.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: April 1, 2010.
Charlene Frizzera,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2010-18139 Filed 7-22-10; 8:45 am]
BILLING CODE 4120-01-P