[Federal Register Volume 79, Number 55 (Friday, March 21, 2014)]
[Notices]
[Pages 15750-15751]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-06158]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5512-N]
Medicare Program; Request for Applications for the Medicare Care
Choices Model
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice informs interested parties of an opportunity to
apply for participation in the Medicare Care Choices Model. The primary
goal of the Medicare Care Choices Model is to test whether Medicare
beneficiaries who meet Medicare hospice eligibility requirements would
elect hospice if they could continue to seek curative services.
DATES: Applications will be considered timely if they are received on
or before June 19, 2014.
Applications received after this date will not be considered.
Applicants must submit their application in a manner that provides
proof of timely delivery, for example, FedEx, UPS, or USPS Express
Mail. It is the applicant's responsibility to be able to prove delivery
of the complete application by the due date.
ADDRESSES: Applications should be mailed to the following address:
Centers for Medicare & Medicaid Services, Center for Medicare and
Medicaid Innovation, Attention: Cindy Massuda, Mail Stop: WB-06-05,
7500 Security Boulevard, Baltimore, Maryland 21244-1850.
FOR FURTHER INFORMATION CONTACT: Cindy Massuda at (410) 786-0652 or
Georganne Kuberski at (410) 786-0799 or by email at address:
[email protected].
The Innovation Center Web site at http://innovation.cms.gov/.
SUPPLEMENTARY INFORMATION:
General Information: In submitting application, refer to file code
(CMS-5512-N).
Application requirements: Applications must be typed for clarity
with a minimum font size of 12 using Microsoft Word and should not
exceed 40 double-spaced pages, exclusive of cover letter, the executive
summary, resumes, and letters of engagement from referring providers.
Follow guidance in this Request for Application for elements to include
in the application, specifically those elements outlined in the
selection criteria.
Submission of Application: Applicants must submit a total of 10
hard copies printed single-sided with page numbers in the bottom right-
hand corner to ensure that each reviewer receives an application in the
manner intended by the applicant (for example, collated, tabulated, or
color copies). Applicants must designate 1 copy as the official
proposal. Applicants must provide 10 hard copies and 1 electronic copy
saved onto a USB flash drive of the full application as the basic
requirement of what constitutes submission of an application. Hard
copies and electronic copies must be identical.
Note: We will not accept applications by any other means such as
facsimile (FAX) transmission or by email.
Eligible Organizations: Eligible providers for this Model are
Medicare certified and enrolled hospice programs based on their
Medicare provider number, in good standing and of all sizes, located in
a mix of rural and urban areas that are experienced in care
coordination with their referring network of providers.
I. Background
The Center for Medicare and Medicaid Innovation (Innovation
Center), within the Centers for Medicare & Medicaid Services (CMS), was
created to test innovative payment and service delivery models to
reduce program expenditures while preserving or enhancing the quality
of care for Medicare, Medicaid, and Children's Health Insurance Program
beneficiaries.
We are interested in identifying models designed to improve care
for specific populations. One such population is terminally ill
Medicare beneficiaries who qualify for, but do not elect to use the
hospice benefit until late in their disease process. There is evidence
that providing hospice care to terminally ill Medicare beneficiaries
can reduce program expenditures while improving beneficiary
satisfaction. Despite this evidence, only 44 percent of Medicare
beneficiaries reach the end of life while using the hospice benefit,
and most use the benefit for only a short period of time. While the
average length of stay on Medicare hospice has grown over time, the
median length of stay has remained stable at about 17 days. The hospice
industry and other stakeholders often cite the requirement to forgo
curative treatment as a primary reason patients do not elect hospice
until the final days of their lives.
[[Page 15751]]
The Medicare Care Choices Model design is based on established
relationships hospices have with their referring network of providers.
Many hospices already have care coordination programs in place to
coordinate hospice support services with the curative care services.
This Model leverages those established relationships to allow Medicare
to test and evaluate this care coordination concept.
The Medicare Care Choices Model seeks to test whether traditional
Medicare beneficiaries with certain types of advanced cancers,
congestive heart failure (CHF), human immunodeficiency virus (HIV), and
chronic obstructive pulmonary disease (COPD) who meet Medicare hospice
eligibility requirements under either the Medicare or Medicaid Hospice
Benefit would elect to receive hospice supportive services earlier in
their disease trajectories if they could continue to seek curative
services. The Model will evaluate whether there are associated
improvements in patient care, patient and family or caregiver
satisfaction with care, and quality of life at the end-of-life.
II. Provisions of This Notice
The Medicare Care Choices Model participating hospices will use
care coordination services both within the hospice and between the
hospice and other providers and suppliers to effectively manage
hospice-eligible Medicare beneficiaries and report process and outcome
measures on their results. The Medicare Care Choices Model
participating hospices will be paid a $400 per beneficiary per month
fee for certain hospice support services furnished to traditional fee-
for-service Medicare beneficiaries who are hospice eligible and meet
the criteria stated in the Request for Application (RFA).
In selecting hospices to participate in the program, CMS seeks
eligible beneficiaries from a mix of rural and urban areas representing
Medicare hospices of all sizes. These hospice providers must
demonstrate experience with care coordination between providers
including physicians, hospitals, pharmacies, DME suppliers, other
suppliers, and skilled nursing facilities.
We expect to select at least 30 Medicare certified and enrolled
hospices based on their Medicare provider number to participate in the
Medicare Care Choices Model. The Medicare Care Choices Model period of
performance will be 3 years. Applicants must present evidence that
their network of referring providers is capable of successfully
identifying beneficiaries who meet the Medicare Care Choice Model
eligibility requirements. Applicants are required to provide a detailed
narrative with supporting documentation describing the beneficiary
population they intend to serve, how services will be provided, the
quality measures in place and planned, and the number of beneficiaries
expected for each year of the 3-year Medicare Care Choices Model
period.
CMS will use a competitive process to select eligible organizations
to participate in the Medicare Care Choices Model. We will accept
timely applications in the standard format outlined in the Medicare
Care Choices Model RFA in order to be considered for review by an
internal technical panel. Applications that are not received in this
format will not be considered for review.
For more specific details regarding the Medicare Care Choices Model
(including the RFA), we refer applicants to the informational materials
on the Innovation Center Web site at: http://innovation.cms.gov/.
Applicants are responsible for monitoring the Web site to obtain the
most current information available.
III. Collection of Information Requirements
Section 1115A(d)(3) of the Act, as added by section 3021 of the
Affordable Care Act, states that chapter 35 of title 44, United States
Code (the Paperwork Reduction Act of 1995), shall not apply to the
testing and evaluation of models or expansion of such models under this
section. Consequently, this document need not be reviewed by the Office
of Management and Budget under the authority of the Paperwork Reduction
Act of 1995 (44 U.S.C. 35).
Dated: November 14, 2013.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2014-06158 Filed 3-18-14; 4:15 pm]
BILLING CODE 4120-01-P