[Federal Register Volume 79, Number 23 (Tuesday, February 4, 2014)]
[Notices]
[Pages 6594-6596]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-02062]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5511-N]
Medicare and Medicaid Programs; Solicitation for Proposals for
the Frontier Community Health Integration Project Demonstration
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice provides eligible entities with the information
necessary to apply for participation in the Frontier Community Health
Integration Project (FCHIP) demonstration. The demonstration is
designed to better integrate the delivery of acute care, extended care
and other health care services, and improve access to care for Medicare
and Medicaid beneficiaries residing in very sparsely populated areas. A
competitive application process will be used to select eligible
entities for participation in this demonstration. The demonstration is
planned for up to 3 years.
DATES: Applications will be considered timely if we receive them on or
before 5 p.m., eastern standard time (E.S.T.) on May 5, 2014.
ADDRESSES: Mail one unbound original and two copies to: Centers for
Medicare & Medicaid Services, Attention: Steven Johnson, 7500 Security
Boulevard, Mail Stop: WB-06-05, Baltimore, Maryland 21244-1850.
In addition, an email copy in MS Word or PDF must be sent to:
[email protected].
FOR FURTHER INFORMATION CONTACT: Steven Johnson, (410) 786-3332 or
[email protected].
[[Page 6595]]
SUPPLEMENTARY INFORMATION: Please refer to file code CMS-5511-N on the
application. Applicants are required to submit one unbound original and
two copies to the address listed in the ADDRESSES section of this
notice. In addition, an email copy in MS Word or PDF must be sent to:
[email protected]. Because of staffing and resource limitations, we
cannot accept applications by facsimile (FAX) transmission.
Applications postmarked after the closing date, or postmarked on or
before the closing date but not received in time, will be considered
late.
I. Background
A. Legislative Authority
Section 123 of the Medicare Improvements for Patients and Providers
Act of 2008, (MIPPA) (Pub. L. 110-275) as amended by section 3126 of
the Patient Protection and Affordable Care Act (Pub. L. 111-148),
authorizes a demonstration project on community health integration
models in certain rural counties to develop and test new models for the
delivery of health care services to better integrate the delivery of
acute care, extended care and other health care services, and improve
access to care for Medicare and Medicaid beneficiaries residing in very
sparsely populated areas.
The authorizing legislation defines distinct roles for this
demonstration for the Centers for Medicare & Medicaid Services (CMS)
and the Health Resources and Services Administration (HRSA) in
developing and implementing this project. HRSA was charged with
awarding grants to eligible entities for the purpose of technical
assistance and informing the Secretary of the Department of Health and
Human Services (Secretary) on the specific needs of frontier
communities, while CMS is to conduct a demonstration testing
alternative reimbursement and administrative strategies.
This demonstration is commonly known as the Frontier Community
Health Integration Project (FCHIP). CMS is hereby requesting
applications for participation in this demonstration from eligible
entities as defined in Section 123(d)(1)(B) of MIPPA. CMS interprets
the eligible entity definition as meaning critical access hospitals
(CAHs) that receive funding through the Rural Hospital Flexibility
Program. The statute limits the Demonstration to no more than 4 States;
it also restricts eligibility to CAHs within States with at least 65
percent of counties with 6 or less persons per square mile. With
respect to these requirements, CMS is limiting applications to CAHs in
Alaska, Montana, Nevada, North Dakota, and Wyoming.
The authorizing legislation mandates that the project last for 3
years. The law authorizes waiver of such provisions of the Medicare and
Medicaid programs as are necessary to conduct the demonstration
project. The authorizing legislation also requires the demonstration to
be budget neutral, that is, to be structured such that Medicare
expenditures under the demonstration do not to exceed the amount which
the Secretary estimates would have been paid if the demonstration
project were not implemented. This notice references CMS's request for
proposals for the FCHIP demonstration, which sets forth project
guidelines, conditions of participation, payment methodology, and
application instructions.
The FCHIP demonstration is designed to improve access to certain
services, the delivery of which is often not feasible at low volumes
under current Medicare reimbursement but if integrated into the local
delivery system, would lead to improved outcomes and greater efficiency
in health care service delivery. Integration of services is intended as
an intervention that is directed by the various providers serving the
community so that the specific health care needs of residents are
addressed in appropriate settings--either inpatient, outpatient, or at
home. The desired outcome is to increase access to health care
services, with the objective of supporting certain services so as to
allow them to be financially feasible given the low patient volumes of
a remote and sparsely populated area. Another objective is to decrease
the number of avoidable hospital admissions, readmissions, and
avoidable transfers to tertiary facilities, such that there is no net
increase in Medicare spending for the affected population. To address
the goal of increasing access with no net cost increase, we have
identified four types of services for which this demonstration will
provide financial support, and promote community health integration--
these are: Nursing facility care within the CAH, telemedicine,
ambulance, and home health. We have selected these services on the
basis of research and literature review. Applicants should identify
additional services of one or more of these types, beyond what is
currently available. Applicants must address the need for these
services, including how they enhance patient care options and the
ability of beneficiaries to remain in their communities; and how
quality of these services will be maintained, to assure care can safely
be provided locally. We will also work in the development process of
this project with State Medicaid agencies on their proposals for
Medicaid-specific reimbursement mechanisms to support access to
community-based health care services.
B. FCHIP Applications
In keeping with the authorizing legislation in section 123 of
MIPPA, entities that meet the eligibility requirements will be able to
apply for the demonstration. Specifically, an eligible entity must be
located in either Alaska, Montana, Nevada, North Dakota, or Wyoming
although CMS will select no more than 4 States to participate in the
demonstration. Each entity in its application will be required to
describe a proposal to enhance health-related services so as to
complement those currently provided within the community and reimbursed
by Medicare, Medicaid, or other third-party payers. The applicant must
describe an integrated system of services and explain how these will
better serve the community's health-related needs.
An entity applying for the demonstration will be required to
demonstrate linkages (either ownership or contractual) with the
providers of the identified additional services, such as nursing home,
telemedicine, home health agency, or ambulance service. Specifically,
to be approved for payment of telemedicine services under the
demonstration's payment methodology, the applicant must demonstrate
effective arrangements with distant site specialists who will
participate in telemedicine linkages with providers within the
communities. In addition, to be approved for ambulance services, the
applicants must show transfer arrangements with essential providers.
Each applicant will be asked to submit an analysis of how its
proposed project will be budget neutral and/or achieve cost savings.
This will include projections of the number of patients that will gain
access to services within the community that are supported by the
demonstration, the cost of these services, and the resulting cost
savings from averting transfers to out-of-area hospitals and/or
avoidable hospitalizations. The applicant will be evaluated on the
plausibility of this analysis, the ability to support projections with
clinical evidence and the sensitivity of cost outcomes to the stated
assumptions of change in services and patient behavior.
Interested and eligible parties can obtain complete solicitation
and supporting information on the CMS
[[Page 6596]]
Web site at: http://innovation.cms.gov/initiatives/index.html. Paper
copies can be obtained by writing to Steven Johnson at the address
listed in the ADDRESSES section of this notice.
II. Collection of Information Requirements
The information collection requirements associated with this notice
are subject to the Paperwork Reduction Act of 1995; however, the
information collection requirements are currently approved under the
information collection request associated with OMB control number 0938-
0880 entitled ``Medicare Waiver Demonstration Applicant.'' Applicants
must submit the Medicare Waiver Demonstration Application to be
considered for this program.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: August 20, 2013.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2014-02062 Filed 1-31-14; 4:15 pm]
BILLING CODE 4120-01-P