[Federal Register Volume 60, Number 119 (Wednesday, June 21, 1995)]
[Notices]
[Pages 32384-32386]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-15115]



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PHYSICIAN PAYMENT REVIEW COMMISSION


Request for Proposals

Agency: Physician Payment Review Commission.

Action: Notice.

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    The Physician Payment Review Commission is soliciting proposals to 
conduct a telephone interview of Medicare beneficiaries who are either 
enrolled in or disenrolled from a Medicare managed care plan. The 
survey's purpose is to gather information about these beneficiaries' 
experiences with Medicare managed care, particularly on beneficiary 
access to care. This notice describes the application procedures, 
general policy considerations, and criteria to be used in reviewing 
applications for prospective grants and contracts submitted to the 
Commission.

Background on the Commission

    The Physician Payment Review Commission was established in 1986 
(P.L. 99-272) to advise the U.S. Congress on physician payment policy 
under Part B of the Medicare program, and its mandate was later 
expanded to include consideration of a broader set of interrelated 
policies affecting the financing, quality, and delivery of health 
services. The 13-member Commission brings together the perspectives of 
physicians and other health professionals, consumers and the elderly, 
purchasers, managed care organizations, and experts in health services 
and health economics research. The Commission maintains a 
multidisciplinary staff that conducts and manages all the analytical 
work that supports its recommendations to the Congress.
    The Commission submits an annual report to the Congress on March 
31. It also submits a series of reports in May of each year concerning 
Medicare expenditures and fee updates, access to care, the financial 
liability of Medicare [[Page 32385]] beneficiaries, and comments on the 
President's budget. The Commission has published analyses and 
recommendations relevant to this solicitation on topics such as 
ensuring access to care for vulnerable populations, approaches to 
health plan quality assurance, and improving Medicare risk program 
payment policy.

Description of Proposal Topic

    Although beneficiary enrollment currently remains low, managed care 
is expected to play an increasingly large role in the future of the 
Medicare program. In response to this expectation, the Commission has 
begun to develop an approach for evaluating Medicare managed care 
enrollees' access to care as a component of its ongoing work in 
monitoring access for beneficiaries generally. Sources of information 
for use in monitoring Medicare managed care enrollees' access to care 
are currently limited, however. Encounter data are unavailable, for 
example. Also, the Medicare Current Beneficiary Survey (MCBS), which 
provides information about beneficiary experience in obtaining care, is 
not a useful source of information on beneficiaries enrolled in managed 
care plans because the number of enrollees in its sample is small and 
geographically clustered.
    Because existing data for monitoring access for this population are 
insufficient, the Commission seeks to develop, test, and field a 
questionnaire for use in surveying Medicare beneficiaries who are 
either enrolled in or disenrolled from Medicare managed care plans. 
This survey would be used to obtain information about Medicare 
beneficiaries' experiences with managed care plans, and how those 
experiences affect their access to care. The managed care experiences 
of certain vulnerable subgroups of the beneficiary population may be 
analyzed and compared to those of the general beneficiary population. 
The survey instrument would use some questions from the MCBS to permit 
comparisons with beneficiaries in the fee-for-service sector, and would 
also adapt or develop other questions more appropriate to managed care. 
The survey results would provide information about beneficiary 
experience with managed care plans that could potentially be used as a 
baseline for comparison with the results of future studies. The 
information is expected to be used by the Commission to help assess the 
effects of potential health policy initiatives and to formulate policy 
recommendations. Also, the Commission expects that the survey will 
yield experience relevant to the design of future Medicare beneficiary 
surveys for the collection of information specific to Medicare managed 
care enrollees.
    In particular, the Commission seeks to gain insight into Medicare 
managed care enrollee and disenrollee experiences with or perception of 
the following:
     access to care, including the timely availability of 
needed services, experience in obtaining a primary care physician upon 
enrollment and in cases where a physician leaves the plan, ability to 
find a physician, waiting times for appointments, travel distance to 
provider, barriers to care, and adequacy of access to specialists, as 
well as the perceived impact of supplemental benefits provided by the 
plan and of case management or disease management programs provided;
     utilization of services, including preventive care, acute 
care, home health care, rehabilitation care, reasons for and experience 
with out-of-plan service utilization, and experience in obtaining 
costly or experimental services in circumstances in which they might be 
indicated;
     level of satisfaction with various aspects of managed care 
experiences, including access to care, quality of care, care management 
or coordination efforts, choice of providers, and financial liability;
     degree of awareness and understanding of managed care plan 
arrangements, including incentives, service arrangements, restrictions 
on or consequences of out-of-plan service use, and enrollees' rights 
and responsibilities;
     aspects of managed care plan enrollment that bear on 
access to care, such as sources of beneficiary information on 
enrollment and options, and experience with the enrollment process;
     primary and contributing reasons for continuing enrollment 
and, where applicable, disenrollment; and
     nature and extent of any problems with discontinuity of 
care when switching to or from a managed care plan, including 
experiences with obtaining or retaining supplemental insurance and with 
changing providers.
    As a component of the survey analysis, the Commission seeks to 
identify characteristics of beneficiaries and of managed care plans 
that affect beneficiary experience with access to care. To that end, 
the survey questionnaire should include background questions on 
relevant characteristics of beneficiaries who have experience in a 
managed care plan and relevant characteristics of the plans they have 
enrolled in or disenrolled from.
    The sample size will be determined by technical feasibility and 
resource constraints. Projects should be bid at the sample size that 
the Offeror believes to be appropriate. For comparability purposes, a 
budget based on a simple size of 2,000 should be included in the 
Offeror's business proposal. The Commission is exempt from Office of 
Management and Budget regulations regarding the clearance of forms and 
survey instruments.
    The contractor will perform the following tasks:
    1. Conduct a review of relevant survey or other research findings.
    2. Refine survey topics, including suggesting additional survey 
topics to meet the Commission's needs, develop the survey instrument in 
consultation with Commission staff, and pilot test the full instrument.
    3. Determine the appropriate sampling design and sample size, and 
select a random sample of Medicare beneficiaries who are either 
enrolled in or disenrolled from a Medicare managed care plan.
    4. Conduct the telephone interviews.
    5. Deliver to the Commission a documented, cleaned, computer data 
file of the responses by July 15, 1996.
    6. Deliver a draft report of the methodology and results of the 
survey to the Commission by August 5, 1996.
    7. Deliver to the Commission the final written report of the 
survey's methodology and results by September 2, 1996.
    The Commission plans to award a contract in September 1995.

Formal Proposals

    Proposals must conform to the requirements specified in the 
Commission's formal Request for Proposals, which will be made available 
to applicants on June 29, 1995. The following provides an outline of 
what should be contained in the formal proposal:
    1. Suggestions for additional topic areas to meet the Commission's 
needs (described more fully in the Request for Proposals) and examples 
of questions to address specific topics of interest.
    2. Plans for developing and testing the survey instrument, 
including the use and adaptation of previously validated questions 
where applicable, and discussion of the types of questions from the 
MCBS that would be most appropriate and useful in obtaining 
comparability of relevant survey results.
    3. Plans for determining the appropriate sampling design and sample 
size, and for obtaining a random sample of beneficiaries who are either 
enrolled or disenrolled from a Medicare managed [[Page 32386]] care 
plan. Plans for oversampling certain groups thought to be vulnerable to 
access problems should be included. The Commission will provide a data 
set of beneficiaries and relevant characteristics for sample 
generation.
    4. Methods to be used to obtain an adequate response rate.
    5. Detailed description of how the interviews will be carried out, 
including the training of interviewers, and method to achieve reliable 
results.
    6. Analysis plan.
    7. Discussion of problems that may be encountered and strategies 
for resolving them.
    8. Work plan including description of tasks, time schedule, level 
of effort for key individuals, and the number of days devoted to each 
task.
    9. Description of the organizational experience and resources and 
the qualifications of key project staff, demonstrating their 
understanding of the Medicare program and managed care, experience with 
the design and conduct of telephone interview surveys of Medicare 
beneficiaries or the elderly, and the ability to complete successfully 
the preceding tasks.
    10. Detailed budget providing justifications and explanations for 
amounts required for each task of the project.

Review of Proposals

    Proposals will be reviewed by a panel composed of at least three 
individuals, at least one of whom will not be affiliated with the 
Commission. Reviewers will score applications and make recommendations 
based on the criteria published in the Commission's Request for 
Proposals, Part IV, Section M, ``Technical Evaluation and Criteria for 
Award.''

General Information

Authority

    The Commission's authority for making these awards is based on 
Section 1845(c)(2)(B) of the Social Security Act (42 U.S.C. Section 
1359w-1).

Regulations

    General policies and procedures that govern the administration of 
contracts and grants are located in Title 45 of the CFR parts 74 and 
92. Applicants are urged to review the requirements contained in those 
regulations.

Submission Address

    Physician Payment Review Commission,2120 L Street NW, Suite 
200,Washington, DC 205037.

Submission Deadline

    In order to be considered under this Request for Proposals, 
complete proposals must be received in the Commission's office no later 
than close of business, Friday, July 28, 1995.

Obligation

    Ths solicitation in no way obligates the Commission to fund any 
applicant.

Date:

    June 15, 1995.

Contact:

    Elizabeth Docteur, Analyst, Physician Payment Review Commission, 
2120 L Street NW., Suite 200, Washington, DC 20037, (202) 653-7220.
Lauren B. LeRoy,
Acting Executive Director.
[FR Doc. 95-15115 Filed 6-20-95; 8:45 am]
BILLING CODE 6820-SE-M