[Federal Register Volume 79, Number 55 (Friday, March 21, 2014)]
[Pages 15750-15751]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-06158]



Centers for Medicare & Medicaid Services


Medicare Program; Request for Applications for the Medicare Care 
Choices Model

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.


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: 
    The Innovation Center Web site at http://innovation.cms.gov/.

    General Information: In submitting application, refer to file code 
    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 
    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 
    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]