[Federal Register Volume 67, Number 81 (Friday, April 26, 2002)]
[Notices]
[Pages 20800-20801]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-10322]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-4047-N]


Medicare Program; Risk Adjustment Training, June 3-4, 2002, Las 
Vegas, NV; June 6-7, 2002, St. Louis, MO; June 10-11, 2002, 
Philadelphia, PA; and June 13-14, 2002, Orlando, FL

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

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces risk adjustment training sessions that 
will provide Medicare+Choice (M+C) organization staff (technical, 
operations, and provider relations) with the necessary knowledge to 
improve the quality and quantity of risk adjustment data. The specific 
training objectives are to understand data and diagnosis coding 
requirements, risk score calculation, the submission process and 
schedule, and the new risk adjustment processing system. These training 
sessions will build on the overview provided at the January 16, 2002 
public meeting held at CMS.

DATES: Training sessions are scheduled for the locations and dates 
listed below:

Las Vegas: Monday, June 3, 2002, Tuesday, June 4, 2002
St. Louis: Thursday, June 6, 2002, Friday, June 7, 2002
Philadelphia: Monday, June 10, 2002, Tuesday, June 11, 2002
Orlando: Thursday, June 13, 2002, Friday, June 14, 2002

ADDRESSES: The training sessions will be held at the addresses listed 
below:

Las Vegas: Harrah's Las Vegas Hotel & Casino, 3475 Las Vegas Boulevard 
South, Las Vegas, NV 89109
St. Louis: Radisson Hotel & Suites St. Louis Downtown, 200 North Fourth 
Street, St. Louis, MO 63102
Philadelphia: Crowne Plaza Philadelphia Center City, 1800 Market 
Street, Philadelphia, PA 19103
Orlando: Wyndham Orlando Resort, 8001 International Drive, Orlando, FL 
32819

FOR FURTHER INFORMATION CONTACT: Kim Slaughter at (301) 519-5388 or e-
mail your questions to [email protected].

SUPPLEMENTARY INFORMATION:

Background

    The Balanced Budget Act of 1997 (BBA) (Pub. L. 105-33) established 
the Medicare+Choice (M+C) program that significantly expanded the 
health care

[[Page 20801]]

options available to Medicare beneficiaries. Under the BBA, the 
Secretary of the Department of Health and Human Services (the 
Secretary) must implement a risk adjustment methodology that accounts 
for variations in per capita costs based on health status and other 
demographic factors for payment to M+C organizations. The BBA also 
gives the Secretary the authority to collect inpatient hospital data 
for discharges on or after July 1, 1997, and additional data for other 
services occurring on or after July 1, 1998. Risk adjustment 
implementation began January 1, 2000 based on the principal inpatient 
discharge diagnosis. Payments to M+C organizations are made at 10 
percent risk adjusted rates and 90 percent demographically adjusted 
rates for years 2000 through 2003. The Medicare, Medicaid, and SCHIP 
Benefits Improvement and Protection Act (BIPA) of 2000, enacted on 
December 21, 2000, stipulates that the risk adjustment methodology for 
2004 and succeeding years should be based on data from inpatient 
hospital and ambulatory settings. BIPA contains a provision that phases 
in future risk adjusted payments as follows: 30 percent in 2004; 50 
percent in 2005; 75 percent in 2006; and 100 percent in 2007.
    The collection of physician encounter data, which began on October 
1, 2000, and hospital outpatient encounter data, which began on April 
1, 2001, was suspended from May 25, 2001 through July 1, 2002. The 
Secretary suspended the submission of physician and hospital outpatient 
encounter data in May 2001 and directed us to develop a risk adjustment 
approach that balances payment accuracy with data burden. Since then, 
we have worked extensively with M+C organizations, their associations, 
and other interested parties to develop a risk adjustment approach that 
reduces the burden of data collection for M+C organizations by about 98 
percent. We have reduced the burden by decreasing the number of data 
elements (from 50 to only 5 elements) to be submitted, only requiring 
submission of diagnoses that are needed for calculating payments, and 
creating a simplified data submission format and processing system. 
Submission of ambulatory risk adjustment data will resume on October 1, 
2002 for dates of service beginning July 1, 2002. Instructions on this 
process will be provided to M+C organizations in April 2002. A new 
processing system will be operational on October 1, 2002 for all types 
of risk adjustment data (hospital inpatient, physician, and hospital 
outpatient).
    We are announcing this training to provide individuals and M+C 
organizations an opportunity to obtain the necessary training to submit 
risk adjustment data accurately, timely, and in accordance with our 
requirements. The training objectives are to understand data coding and 
requirements, risk score calculation, the submission process and 
schedule, and the new risk adjustment processing system. The agenda 
will include presentations by our staff and Aspen Systems Corporation 
staff, and question-and-answer sessions.
    The training will consist of the following topics:
     Background of risk adjustment methodology.
     Overview of the risk adjustment process.
     Data collection.
     Risk adjustment processing system file format.
     Risk adjustment processing system edits.
     Reports/error resolutions.
     Health plan management system overview.
    A copy of the training agenda is available at: www.aspenxnet.com/meetingagenda.htm
    This training is designed for M+C organization staff responsible 
for collection and submission of risk adjustment data, third party 
contractors that submit risk adjustment data on behalf of an M+C 
organization, and M+C provider training staff.

Registration

    Registration for this training is required. Each training site has 
a limited number of spaces available for participants. Therefore, 
registration for M+C organizations is limited to two attendees for all 
locations and is on a first come, first served basis. M+C organization 
staff will receive priority registration consideration due to training 
space limitations. If an M+C organization has contracted with a third 
party to submit risk adjustment data and the third party wants to 
attend the training, indicate this information under ``Type of 
Organization'' on the registration form. A waiting list will be 
available for additional requests.
    Registration can be completed via the Internet at the following Web 
site: www.aspenxnet.com/registration. A confirmation notice with 
additional training location information will be sent to attendees upon 
finalization of registration. Attendees will be responsible for the 
cost and arrangement of their own transportation, lodging, and meals.
    Attendees will be provided with training materials at the time of 
the training. After the scheduled training sessions, materials will be 
available at www.hcfa.gov and www.cms.hhs.gov.

(Authority: Sections 1851 through 1859 of the Social Security Act 
(42 U.S.C. 1395w-21 through 1395w-28)).


    Dated: April 23, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 02-10322 Filed 4-25-02; 8:45 am]
BILLING CODE 4120-01-P