[Federal Register Volume 60, Number 241 (Friday, December 15, 1995)]
[Notices]
[Pages 64440-64444]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-30559]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[ORD-082-N]
New and Pending Demonstration Project Proposals Submitted
Pursuant to Section 1115(a) of the Social Security Act
October 1995.
AGENCY: Health Care Financing Administration (HCFA, HHS).
ACTION: Notice.
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SUMMARY: This notice lists new proposals for Medicaid demonstration
projects submitted to the Department of Health and Human Services
during the month of October 1995 under the authority of section 1115 of
the Social Security Act. This notice also lists proposals that were
approved, disapproved, pending, or withdrawn during this time period.
(This notice can be accessed on the Internet at HTTP://WWW.SSA.GOV/
HCFA/HCFAHP2.HTML.)
COMMENTS: We will accept written comments on these proposals. We will,
if feasible, acknowledge receipt of all comments, but we will not
provide written responses to comments. We will, however, neither
approve nor disapprove any new proposal for at least 30 days after the
date of this notice to allow time to receive and consider comments.
Direct comments as indicated below.
ADDRESSES: Mail correspondence to: Susan Anderson, Office of Research
and Demonstrations, Health Care Financing Administration, Mail Stop C3-
11-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.
FOR FURTHER INFORMATION CONTACT: Susan Anderson, (410) 786-3996.
SUPPLEMENTARY INFORMATION:
I. Background
Under section 1115 of the Social Security Act (the Act), the
Department of Health and Human Services (HHS) may consider and approve
research and demonstration proposals with a broad range of policy
objectives. These demonstrations can lead to improvements in achieving
the purposes of the Act.
In exercising her discretionary authority, the Secretary has
developed a number of policies and procedures for reviewing proposals.
On September 27, 1994, we published a notice in the Federal Register
(59 FR 49249) that specified (1) the principles that we ordinarily will
consider when approving or disapproving demonstration projects under
the authority in section 1115(a) of the Act; (2) the procedures we
expect States to use in involving the public in the development of
proposed demonstration projects under section 1115; and (3) the
procedures we ordinarily will follow in reviewing demonstration
proposals. We are committed to a thorough and expeditious review of
State requests to conduct such demonstrations.
As part of our procedures, we publish a notice in the Federal
Register with a monthly listing of all new submissions, pending
proposals, approvals, disapprovals, and withdrawn proposals. Proposals
submitted in response to a grant solicitation or other competitive
process are reported as received during the month that such grant or
bid is awarded, so as to prevent interference with the awards process.
II. Listing of New, Pending, Approved, and Withdrawn Proposals for the
Month of October 1995
A. Comprehensive Health Reform Programs
1. New Proposals
No new proposals were received during the month of October.
2. Pending Proposals
Demonstration Title/State: Better Access for You (BAY) Health Plan
Demonstration--Alabama.
Description: Alabama proposes to create a mandatory managed care
delivery system in Mobile County for non-institutionalized Medicaid
beneficiaries and an expansion population of low-income women and
children. The network, called the Bay Health Network, would be
administered by the PrimeHealth Organization, which is owned by the
University of South Alabama Foundation. The State also proposes to
expand family planning benefits for pregnant women whose income is less
than 133 percent of the Federal poverty level.
Date Received: July 10, 1995.
State Contact: Vicki Huff, Director, Managed Care Division, Alabama
Medicaid Agency, P.O. Box 5624, Montgomery, AL 36103-5624, (334) 242-
5011.
Federal Project Officer: Maria Boulmetis, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Arizona Health Care Cost Containment
System (AHCCCS)--Arizona.
Description: Arizona proposes to expand eligibility under its
current section 1115 AHCCCS program to individuals with incomes up to
100 percent of the Federal poverty level.
Date Received: March 17, 1995
State Contact: Mabel Chen, M.D., Director, Arizona Health Care Cost
Containment System, 801 East Jefferson, Phoenix, AZ 85034, (602) 271-
4422.
Federal Project Officer: Joan Peterson, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: The Georgia Behavioral Health Plan--
Georgia.
Description: Georgia proposes to provide behavioral health services
under a managed care system through a
[[Page 64441]]
section 1115 demonstration. The plan would be implemented by regional
boards that would contract with third party administrators to develop a
network of behavioral health providers. The currently eligible Medicaid
population would be enrolled in the program and would have access to a
full range of behavioral health services. Once the program realizes
savings, the State proposes to expand coverage to individuals who are
not otherwise eligible for Medicaid.
Date Received: September 1, 1995.
State Contact: Margaret Taylor, Coordinator for Strategic Planning,
Department of Medical Assistance, 1 Peachtree Street, NW, Suite 27-100,
Atlanta, GA 30303-3159, (404) 657-2012.
Federal Project Officer: Nancy Goetschius, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
Demonstration Title/State: MediPlan Plus--Illinois.
Description: Illinois seeks to develop a managed care delivery
system using a series of networks, either local or statewide, to tailor
its Medicaid delivery system to the needs of local urban neighborhoods
or large rural areas.
Date Received: September 15, 1994.
State Contact: Tom Toberman, Manager, Federal/State Monitoring, 201
South Grand Avenue East, Springfield, IL 62763, (217) 782-2570.
Federal Project Officer: Gina Clemons, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Community Care of Kansas--Kansas.
Description: Kansas proposes to implement a ``managed cooperation
demonstration project'' in four predominantly rural counties, and to
assess the success of a non-competitive managed care model in rural
areas. The demonstration would enroll persons currently eligible in the
Aid to Families with Dependent Children (AFDC) and AFDC-related
eligibility categories, and expand Medicaid eligibility to children
ages 5 and under with family incomes up to 200 percent of the Federal
poverty level.
Date Received: March 23, 1995.
State Contact: Karl Hockenbarger, Kansas Department of Social and,
Rehabilitation Services, 915 Southwest Harrison Street, Topeka, KS
66612, (913) 296-4719.
Federal Project Officer: Jane Forman, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-21-
04, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Louisiana Health Access--Louisiana.
Description: Louisiana proposes to implement a fully capitated
statewide managed care program. A basic benefit package and a
behavioral health and pharmacy wrap-around would be administered
through the managed care plans. The State intends to expand Medicaid
eligibility to persons with incomes up to 250 percent of the Federal
poverty level; those with incomes above 133 percent of the Federal
poverty level would pay all or a portion of premiums.
Date Received: January 3, 1995.
State Contact: Carolyn Maggio, Executive Director, Bureau of
Research and Development, Louisiana Department of Health and Hospitals,
P.O. Box 2870, Baton Rouge, LA 70821-2871, (504) 342-2964.
Federal Project Officer: Gina Clemons, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Missouri.
Description: Missouri proposes to require Medicaid beneficiaries to
enroll in managed care delivery systems, and extend Medicaid
eligibility to persons with incomes below 200 percent of the Federal
poverty level. As part of the program, Missouri would create a fully
capitated managed care pilot program to serve non-institutionalized
persons with permanent disabilities on a voluntary basis.
Date Received: June 30, 1994.
State Contact: Donna Checkett, Director, Division of Medical
Services, Missouri Department of Social Services, P.O. Box 6500,
Jefferson City, MO 65102-6500, (314) 751-6922.
Federal Project Officer: Nancy Goetschius, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: The Granite State Partnership for Access
and Affordability in Health Care--New Hampshire.
Description: New Hampshire proposes to extend Medicaid eligibility
to adults with incomes below the AFDC cash standard and to create a
public insurance product for low- income workers. The State also seeks
to implement a number of pilot initiatives to help redesign its health
care delivery system.
Date Received: June 14, 1994.
State Contact: Barry Bodell, New Hampshire Department of Health and
Human Services, Office of the Commissioner, 6 Hazen Drive, Concord, NH
03301-6505, (603) 271-4332.
Federal Project Officer: Maria Boulmetis, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: The Partnership Plan--New York.
Description: New York proposes to move most of the currently
eligible Medicaid population and Home Relief (General Assistance)
populations from a primarily fee-for-service system to a managed care
environment. The State also proposes to establish special needs plans
to serve individuals with HIV/AIDS and certain children with mental
illnesses.
Date Received: March 17, 1995.
State Contact: Richard T. Cody, Deputy Commissioner, Division of
Health and Long Term Care, 40 North Pearl Street, Albany, NY 12243,
(518) 474-9132.
Federal Project Officer: Debbie Van Hoven, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: State of Texas Access Reform (STAR)--
Texas.
Description: Texas is proposing a section 1115 demonstration that
will restructure the Medicaid program using competitive managed care
principles. A focal point of the proposal is to utilize local
governmental entities (referred to as Intergovernmental Initiatives
(IGIs)) and to make the IGI responsible for designing and administering
a managed care system in its region. Approximately 876,636 new
beneficiaries would be served during the 5-year demonstration in
addition to the current Medicaid population. Texas proposes to
implement the program in June 1996.
Date Received: September 6, 1995.
State Contact: Cathy Rossberg, State Medicaid Office, P.O. Box
13247, Austin, TX 78711, (512) 502-3224.
Federal Project Officer: Alisa Adamo, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Section 1115 Demonstration Waiver for
Medicaid Expansion--Utah.
Description: Utah proposes to expand eligibility for Medicaid to
all individuals with incomes up to 100 percent of the Federal poverty
level
[[Page 64442]]
(subject to limited cost sharing) and to enroll all Medicaid
beneficiaries in managed care plans. The State also proposes to
streamline eligibility and administrative processes and to develop a
subsidized small employer health insurance plan.
Date Received: July 5, 1995.
State Contact: Michael Deily, Acting Division Director, Utah
Department of Health, Division of Health Care Financing, 288 North 1460
West, P.O. Box 142901, Salt Lake City, UT 84114-2901, (801) 538-6406.
Federal Project Officer: David Walsh, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
3. Approved Conceptual Proposals (Awards of Waivers Pending).
No conceptual proposals were approved during the month of October.
4. Approved Grant Proposals (Award of Waivers Pending).
No grant proposals were awarded during the month of October.
5. Approved Proposals.
The following comprehensive health reform proposals were approved
during the month of October.
Demonstration Title/State: Kentucky Partnership Plan--Kentucky.
Description: The State was awarded a demonstration to implement the
``Kentucky Partnership Plan,'' an amendment to its original proposal.
Under the demonstration, the State will be divided into eight managed
care regions incorporating both public and private providers into a
single managed care network which will offer the standard State
Medicaid benefit package to all non-institutionalized Medicaid
beneficiaries. Mental health and long-term care services will continue
to be offered through the fee-for-service system.
Date Received: June 19, 1995.
Date Approved: October 6, 1995.
State Contact: Larry A. McCarthy, Commonwealth of Kentucky,
Department for Medicaid Services, 275 East Main Street, Frankfort, KY
40621, (502) 564-8196.
Federal Contact: Maria Boulmetis, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: SoonerCare--Oklahoma.
Description: Oklahoma will implement a 5-year statewide managed
care demonstration using both fully and partially capitated delivery
systems. The emphasis of the program is to address access problems in
rural areas by encouraging the development of rural-based managed care
initiatives. The State will employ traditional fully capitated managed
care delivery models for urban areas and will introduce a series of
partial capitation models in the rural areas of the State. All
currently eligible, non-institutionalized Medicaid beneficiaries will
be enrolled during the first 2 years of the project.
Date Received: January 6, 1995.
Date Approved: October 12, 1995.
State Contact: Leigh Brown, Oklahoma Health Care Authority, 4545
North Lincoln Blvd., Suite 124, Oklahoma City, Oklahoma 73105, (405)
530-3269.
Federal Project Officer: Patricia Selinger, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
6. Disapproved Proposals
No comprehensive health reform proposals were disapproved during
the month of October.
7. Withdrawn Proposals
No comprehensive health reform proposals were withdrawn during the
month of October.
B. Other Section 1115 Demonstration Proposals
1. New Proposals
The following proposal was received during the month of October:
Demonstration/Title: Medicaid Family Planning Services for Women
of Childbearing Age--Arkansas.
Description: Arkansas seeks to extend Medicaid eligibility for
family planning services only to postpartum women under 133 percent
of the Federal poverty level who would have lost benefits 60 days
after delivery. The demonstration will streamline the application
process for these women and make income requirements less stringent.
Women will be eligible for family planning benefits for 5 years or
the length of the demonstration.
Date Received: October 2, 1995.
State Contact: David Rickard, Arkansas Department of Human
Services, 329 Donaghey Building, P.O. Box 1437, Little Rock, AK
72203-1437, (501) 682-8650.
Federal Contact: Rosemarie Hakim, Ph.D, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-
24-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.
2. Pending Proposals
Demonstration Title/State: Alternatives in Medicaid Home Care
Demonstration--Colorado.
Description: Colorado proposes to conduct a pilot project that
eliminates the restriction on provision of Medicaid home health
services in locations other than the beneficiary's place of
residence. The proposal would also permit nursing aides to perform
functions that historically have been provided only by skilled
nursing staff. Medicaid beneficiaries participating in the project
will be adults (including both frail elderly clients and younger
clients with disabilities) who can live independently and self-
direct their own care. The project would provide for delegation of
specific functions from nurses to certified nurses aides, pay nurses
for shorter supervision and monitoring visits, and allow higher
payments to aides performing delegated nursing tasks. Currently,
home health agency nursing and nurse aide services are paid on a per
visit basis. Each visit is approximately 2-4 hours in duration, and
recipients must require skilled, hands-on care.
Date Received: June 3, 1995.
State Contact: Dann Milne, Director, Department of Health Care
Policy, and Financing, 1575 Sherman Street, Denver, CO 80203-1714,
(303) 866-5912.
Federal Project Officer: Phyllis Nagy, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-
21-06, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration/Title: Integrated Care and Financing Project
Demonstration--Colorado.
Description: Colorado proposes to conduct an Integrated Care and
Financing Project demonstration. Specifically, the Colorado
Department of Health Care Policy and Financing proposes to add
institutional and community-based long-term care services to a
health maintenance organization (HMO) and make the HMO responsible
for providing comprehensive medical and supportive services through
one capitated rate. The project would include all Medicaid
eligibility groups, including individuals with dual eligibility.
Date Received: September 28, 1995.
State Contact: Dann Milne, Office of Long-Term Care System
Development, State of Colorado Department of Health Care Policy and
Financing, 1575 Sherman Street, Denver, CO 80203-1714, (303) 866-
5912.
Federal Contact: Melissa McNiff, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-
18-26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Georgia's Children's Benefit Plan--
Georgia.
Description: Georgia submitted a section 1115 proposal entitled
``Georgia Children's Benefit Plan'' to provide preventive and
primary care services to children aged 1 through 5 living in
families with incomes between 133 percent and 185 percent of the
Federal poverty level. The duration of the project is 5 years with
proposed project dates of July 1, 1995 to June 30, 2000.
Date Received: December 12, 1994.
State Contact: Jacquelyn Foster-Rice, Georgia Department of
Medical Assistance, 2 Peachtree Street Northwest, Atlanta, GA 30303-
3159, (404) 651-5785.
Federal Project Officer: Maria Boulmetis, Health Care Financing,
Administration, Office of Research and Demonstrations, Mail
[[Page 64443]]
Stop C3-18-26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Family Planning Services Section 1115
Waiver Request--Michigan.
Description: Michigan seeks to extend Medicaid eligibility for
family planning services to all women of childbearing age with incomes
at or below 185 percent of the Federal poverty level, and to provide an
additional benefit package consisting of home visits, outreach services
to identify eligibility, and reinforced support for utilization of
services. The duration of the project is 5 years.
Date Received: March 27, 1995.
State Contact: Gerald Miller, Director, Department of Social
Services, 235 South Grand Avenue, Lansing, MI 48909, (517) 335-5117.
Federal Project Officer: Suzanne Rotwein, Ph.D., Health Care
Financing Administration, Office of Research and Demonstrations, Mail
Stop C3-24-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Montana Mental Health Access Plan--
Montana.
Description: Montana proposes to provide all mental health services
for current Medicaid-eligible individuals through managed care and to
expand Medicaid eligibility to persons with incomes up to 200 percent
of the Federal poverty level. Newly eligible individuals would receive
only mental health benefits, and would not be eligible for other health
services under the demonstration. A single statewide contractor would
provide the mental health services and also determine eligibility,
perform inspections, and handle credentialing.
Date Received: June 16, 1995.
State Contact: Nancy Ellery, State Medicaid Director, Department of
Social and Rehabilitation Services, P.O. Box 4210, 111 North Sanders,
Helena, MT 59604-4210, (406) 444-4540.
Federal Project Officer: Nancy Goetschius, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Family Planning Proposal--New Mexico.
Description: New Mexico proposes to extend Medicaid eligibility for
family planning services to all women of childbearing age with incomes
at or below 185 percent of the Federal poverty level.
Date Received: November 1, 1994.
State Contact: Bruce Weydemeyer, Director, Division of Medical
Assistance, P.O. Box 2348, Santa Fe, NM 87504-2348, (505) 827-3106.
Federal Project Officer: Suzanne Rotwein, Ph.D., Health Care
Financing Administration, Office of Research and Demonstrations, Mail
Stop C3-24-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: CHOICES--Citizenship, Health,
Opportunities, Interdependence, Choices and Supports--Rhode Island.
Description: Rhode Island proposes to consolidate all current State
and Federal funding streams for adults with developmental disabilities
under one program using managed care/managed competition.
Date Received: April 5, 1994.
State Contact: Susan Babin, Department of Mental Health,
Retardation, and Hospitals, Division of Developmental Disabilities, 600
New London Avenue, Cranston, RI 02920, (401) 464-3234.
Federal Project Officer: Melissa McNiff, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-21-
06, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Family Planning Services Eligibility
Requirements Waiver--South Carolina.
Description: South Carolina proposes to extend Medicaid coverage
for family planning services for 22 additional months to postpartum
women with monthly incomes under 185 percent of the Federal poverty
level. The objectives of the demonstration are to increase the number
of reproductive age women receiving either Title XIX or Title X funded
family planning services following the completion of a pregnancy,
increase the period between pregnancies among mothers eligible for
maternity services under the expanded eligibility provisions of
Medicaid, and estimate the overall savings in Medicaid spending
attributable to providing family planning services to women for 2 years
postpartum. The duration of the proposed project would be 5 years.
Date Received: May 4, 1995.
State Contact: Eugene A. Laurent, Executive Director, State Health
and Human Services Finance Commission, P.O. Box 8206, Columbia, SC
29202-8206, (803) 253-6100.
Federal Project Officer: Suzanne Rotwein, Ph.D., Health Care
Financing Administration, Office of Research and Demonstrations, Mail
Stop C3-24-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Demonstration Title/State: Wisconsin.
Description: Wisconsin proposes to limit the amount of exempt funds
that may be set aside as burial and related expenses for SSI-related
Medicaid beneficiaries.
Date Received: March 9, 1994.
State Contact: Jean Sheil, Division of Economic Support, Wisconsin
Department of Health and Social Services, 1 West Wilson Street, Room
650, P.O. Box 7850, Madison, WI 53707, (608) 266-0613.
Federal Project Officer: J. Donald Sherwood, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-16-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
3. Approved Conceptual Proposals (Award of Waivers Pending)
No conceptual proposals were awarded during the month of October.
4. Approved Proposals
The following proposal was approved during the month of October.
Demonstration Title/State: Demonstration of Integrated Care
Management Systems for High-Cost/High-Risk Medicaid Beneficiaries--
Maryland.
Description: Maryland is testing a new case management delivery
system for high-cost/high-risk Medicaid beneficiaries and those at risk
to become high-cost. The program seeks to maintain or improve access to
providers and the quality of the care provided. The demonstration also
should lower health care costs by reducing hospital readmission rates
and by maintaining patients in the lowest-cost medically appropriate
setting. The University of Maryland Baltimore County Center for Health
Program Development and Management, under contract to the State, is
responsible for the demonstration's operations.
Date Received: July 8, 1994.
Date Approved: October 6, 1995.
State Contact: Martin P. Wasserman, M.D., J.D., Department of
Health and Mental Hygiene, State of Maryland, 201 West Preston Street,
Baltimore, MD 21201, (410) 225-6500.
Federal Project Officer: William D. Clark, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-21-
06, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
5. Disapproved Proposals
No proposals were disapproved during the month of October.
6. Withdrawn Proposals
No proposals were withdrawn during the month of October.
[[Page 64444]]
IV. Requests for Copies of a Proposal
Requests for copies of a specific Medicaid proposal should be made
to the State contact listed for the specific proposal. If further help
or information is needed, inquiries should be directed to HCFA at the
address above.
(Catalog of Federal Domestic Assistance Program, No. 93.779; Health
Financing Research, Demonstrations, and Experiments.)
Dated: December 8, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 95-30559 Filed 12-14-95; 8:45 am]
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