[Federal Register Volume 64, Number 55 (Tuesday, March 23, 1999)]
[Notices]
[Pages 13998-13999]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-7079]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-1100-N]
RIN 0938-AJ49


Medicare Program; Medicare Coordinated Care Demonstration Project 
and Request for Information on Potential Best Practices of Coordinated 
Care

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Solicitation of information.

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SUMMARY: This notice announces our intent to conduct the Medicare 
Coordinated Care Demonstration. It informs interested parties of the 
opportunity to submit information on examples of best practices of 
coordinated care, as well as comment on potential aspects of the 
overall Medicare Coordinated Care demonstration.
    Section 4016 of the Balanced Budget Act of 1997 requires a review 
of best practices and, following this assessment, a Medicare 
Coordinated Care Demonstration to be launched by August 1999.
    The purpose of the demonstration is to evaluate models of 
coordinated care that improve the quality of services furnished to 
specific beneficiaries and reduce expenditures under Parts A and B of 
the Medicare program.

EFFECTIVE DATE: Information and comments will be considered if we 
receive them at the address provided below, no later than 5 p.m., June 
21, 1999.

ADDRESSES: Mail written comments (1 original and 3 copies) to the 
following address: Mathematica Policy Research, Inc., Attn: Ms. Kristin 
LaBounty, P.O. Box 2393, Princeton, NJ 08543-2393.
    Comments may also be submitted electronically to Ms. LaBounty's e-
mail address (K[email protected]). Electronically submitted 
comments should not include attachments.
    Because of staffing and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. In commenting, please refer 
to file code HCFA-1100-N.

FOR FURTHER INFORMATION CONTACT: Kathy Headen, Acting HCFA Project 
Officer, (410) 786-9253 or Kristin LaBounty, (609) 275-2263.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 4016 of the Balanced Budget Act of 1997 (Public Law 105-33) 
requires the Secretary of Health and Human Services (the Secretary) to 
evaluate best practices in the private sector for methods of 
coordinated care. The statute also directs the Secretary to design 
demonstration projects for the Medicare fee-for-service population 
based on the evaluation. The purpose of the demonstration is to 
evaluate models of coordinated care that improve the quality of 
services provided to specific beneficiaries who have a chronic illness 
and reduce expenditures under Parts A and B of the Medicare program.
    We competitively awarded a task order for conducting a review of 
best practices in coordinated care and for providing a recommendation 
of demonstration design options to Mathematica Policy Research, Inc. 
(MPR). We will perform the final assessment of best practices and 
select the demonstration design.

II. Provisions of This Notice

    This notice announces our intent to conduct the Medicare 
Coordinated Care Demonstration and informs interested parties of the 
opportunity to submit information on potential best practices of 
coordinated care. In addition, this notice also requests comments on 
potential aspects of the overall demonstration. We are looking for 
information on successful models of coordinated care, disease 
management, or case management that are appropriate for the Medicare 
fee-for-service population.
    Information about, and evidence of, successful models can be found 
in published literature; however, published literature is likely to be 
a limited resource and successful programs may not have been 
documented. Therefore, we would like to give interested parties the 
opportunity to submit information about models of coordinated care that 
are known to have achieved measurable success but may not have been 
discussed in published literature.
    We anticipate this information will complement the review being 
conducted by MPR. Additional information regarding MPR's review can be 
found on their website (www.mathematica-mpr.com/projects/
bestpractices).
    Any person or organization may submit information about successful 
programs; however, the information must provide evidence of success in 
sufficient detail to be useful. Therefore, operators of programs may be 
in the best position to submit information regarding their approach. 
The following items of information should be submitted:
     The name and address of the program.
     The name, address, telephone number, facsimile number, and 
e-mail address of a contact person.
     Background on the program (including goals, history, 
relationship to larger organization(s), number of clients served, and 
length of time the program has been in operation).
     Special or innovative features of the program.
     Size and composition of the staff (number of RNs and 
number of social workers performing case management).

[[Page 13999]]

     Referral sources, targeting criteria, and selection 
criteria, if any, for participants.
     The patients served by the program (including age ranges, 
diagnoses or conditions, and functional impairments).
     Program intervention and how services differ from the 
usual care the patient would have received.
     How care plans are developed and monitored for each 
patient.
     Patient education efforts, if any.
     Patient monitoring efforts, if any.
     Feedback to providers, if any.
     Average length of time patient is in the program.
     Funding source(s) for the program.
     Financial incentives, if any, for providers and patients 
to participate.
     Outcome measures by which the program's performance is 
evaluated (including clinical, utilization, client-reported, and 
financial measures used).
     Program impacts on these measures.
     Cost savings due to the program (total and per person 
served per month).
     How program impacts and cost savings were calculated (for 
example, method of estimating reduction in use and costs, such as 
comparison to control group or prior year experience).
     Costs of operating the program (average per patient per 
month costs).
     Adaptability of the program to the Medicare fee-for-
service setting.
     Program brochures or published articles, if any.
    We are also interested in comments on potential aspects of the 
overall demonstration. Specifically, we are interested in comments that 
discuss and distinguish program characteristics known to be essential 
for positive outcomes in a fee-for-service setting. Commenters may also 
wish to address the types of providers, organizations, or entities 
capable of, and qualified to provide, coordinated care or case 
management services. Other aspects of importance include, but are not 
limited to:
     The relationship of the case management entity with other 
providers.
     The potential role of the case manager in authorizing or 
providing services beyond coordinating and educational activities.
     Appropriate incentives for the case management entity, 
beneficiaries, and other providers.
     Appropriate payment methodology.
     Potential risk bearing arrangements for the case 
management entity.
    In addition, we seek comments regarding challenges to, and 
potential solutions for, implementing a coordinated care demonstration 
in rural sites.
    We currently envision evaluating the data using a multi-tiered 
review process that will focus on structure, process, and outcomes. 
Review of individual programs will include the following review 
criteria:
     Programs that are currently functioning.
     Programs that decrease health care costs or utilization 
without adversely affecting health outcomes or that improve health 
outcomes without increasing health care costs or utilization.
     Programs that are suitable for the Medicare fee-for-
service population.
     Programs that are targeted to common diseases in the 
Medicare population.
    We will also examine a program's structural characteristics and 
specific features of its program interventions.
    Responders should submit written information or comments to the 
above address. We encourage the public to submit information or 
comments as soon as possible to permit the maximum amount of time for 
consideration. Written information or comments received by 5 p.m., June 
21, 1999, will be considered in drafting the demonstration design 
recommendations. Given the timeline for establishing this 
demonstration, there will not be sufficient time to consider 
information or comments received after this deadline.

III. Collection of Information Requirements

    Section II of this notice contains information collection 
requirements that were approved by the Office of Management and Budget 
under the Paperwork Reduction Act of 1995 on January 5, 1999. The 
approval number is 0938-0750 and the expiration date is June 30, 1999.

    Authority: Section 4016 of the Balanced Budget Act of 1997 
(Public Law 105-33).

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program; 
and No. 93.774, Medicare--Supplementary Medical Insurance Program)

    Dated: March 16, 1999.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 99-7079 Filed 3-22-99; 8:45 am]
BILLING CODE 4120-01-P