[Federal Register Volume 76, Number 245 (Wednesday, December 21, 2011)]
[Notices]
[Pages 79193-79194]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-32568]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5048-N]
Medicare Program; Independence at Home Demonstration Program
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice creates a new demonstration program for
chronically ill Medicare beneficiaries to test a payment incentive and
service delivery system that utilizes physician and nurse practitioner
directed home-based primary care teams aimed at improving health
outcomes and reducing expenditures, beginning December 21, 2011.
DATES: Effective Date: This notice is effective on December 21, 2011.
Application Deadline: February 6, 2012 at 5 p.m., Eastern Standard
Time (E.S.T.).
FOR FURTHER INFORMATION CONTACT:
Linda Colantino (410) 786-3343.
Jennifer Brown (410) 786-4036.
SUPPLEMENTARY INFORMATION:
I. Background
Section 3024 of the Patient Protection and Affordable Care Act of
2010 (the Affordable Care Act) (Pub. L. 111-148, enacted on March 23,
2010), amends title XVIII of the Social Security Act (the Act) by
establishing the Independence at Home (IAH) Demonstration.
The IAH Demonstration will test a service delivery model that
utilizes physician and nurse practitioner directed primary care teams
to provide services to high cost, chronically ill Medicare
beneficiaries in their homes. Participating practices will be
accountable for providing comprehensive, coordinated, continuous, and
accessible care to high-need populations at home and coordinate health
care across all treatment settings. Participating practices may share
in savings under the demonstration if specified quality measures and
savings targets are achieved.
II. Provisions of the Notice
We are seeking interested practices that can provide home-based
primary care to Medicare beneficiaries for purposes of this
demonstration. We anticipate that a wide variety of interested
practices may be eligible to apply to the IAH Demonstration. The
participants in the Demonstration will be multidisciplinary teams
composed of various members such as physicians, nurse practitioners,
physician assistants, pharmacists, social workers, and other supporting
staff. The practices must be led by physicians or nurse practitioners
and must have experience providing home-based primary care to patients
with multiple chronic illnesses. These practices will also be
organized, at least in part, for the purpose of providing physician
services. Qualifying practices may share in savings. Providers cannot
be participating in section 1899 of the Act, the Medicare Shared
Savings Program, or other Medicare shared savings programs at the time
of the Demonstration.
Each participating practice must provide services to at least 200
applicable beneficiaries during each year of the demonstration. A
practice's enrollment may vary over each year but must reach at least
an average of 200 applicable beneficiaries during the first year and
not drop below that average for the remainder of the demonstration.
There are three options available for practices to apply for the
Demonstration. Practices may apply as a sole legal entity, consortium,
or become a part of a national pool. These three options are for the
purpose of establishing expenditure targets and determining incentive
payments. Practices must enroll all existing patients meeting
beneficiary eligibility criteria.
Participating practices will make in-home visits tailored to an
individual patient's needs. Each practice must be available 24 hours
per day, 7 days a week to carry out plans of care. Practices must use
electronic health information systems, remote monitoring, and mobile
diagnostic technology.
Applicable beneficiaries are defined as Medicare fee-for-service
(FFS) patients, who have at least 2 chronic illnesses, need assistance
with 2 or more functional dependencies requiring the assistance of
another person, have had a nonelective hospital admission within the
last 12 months, and have received acute or subacute rehabilitation
services within the last 12 months. Beneficiaries to be included in the
Demonstration must be entitled to Medicare part A and enrolled in
Medicare part B, not enrolled in a Medicare Advantage plan or a Program
for All-Inclusive Care for the Elderly, and cannot be enrolled in a
practice that is part of the Medicare Shared Savings Program or other
program that shares Medicare savings.
We will establish a practice-specific spending target derived from
claims, based on expected Medicare FFS utilization for each of the
beneficiaries in the practices in the absence of the Demonstration.
Annual spending targets will be calculated for each participating
practice at the end of each performance year. The spending target will
be derived from a base expenditure amount equal to the average payments
under Medicare Part A and Part B. Savings will be calculated as the
difference between each practice's spending target and actual costs.
Practices will also be required to meet quality performance standards
in order to share in any savings. Under this 3-year demonstration, IAH
providers will continue to bill and be paid standard Medicare FFS
reimbursement.
Applicants must submit completed applications following the format
outlined in the Demonstration application instructions in order to be
considered for review by CMS. Applications not received in this format
will not be considered for review.
For the Project Application and specific details regarding the IAH
Demonstration, please refer to the CMS Web site at http://www.cms.gov/
[[Page 79194]]
DemoProjectsEvalRpts/downloads/IAH--FactSheet.pdf
Please refer to file code [CMS-5048-N] on the Application.
Applicants must submit at least 1 electronic copy on CD-ROM of the
Application and are required to submit a paper version of the
Application with an original signature. Because of staffing and
resource limitations, we cannot accept applicationss by facsimile (FAX)
transmission. Hard copies and electronic copies must be identical.
Applications for practices applying to the IAH Demonstration will
be considered timely if they are received on or before 5 p.m., Eastern
Standard Time (E.S.T.) on the date listed in the DATES section of this
notice.
III. Collection of Information Requirements
Accordance to section 3024 of the Affordable Care Act this notice
does not impose information collection and recordkeeping requirements.
Consequently, it 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).
Authority: Section 3024 of the Affordable Care Act.
(Catalog of Federal Domestic Assistance Program No. 93.778,
Medicare--Supplementary Medical Insurance Program)
Dated: September 9, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-32568 Filed 12-20-11; 8:45 am]
BILLING CODE 4120-01-P