[Federal Register Volume 67, Number 249 (Friday, December 27, 2002)]
[Notices]
[Pages 79122-79123]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-31410]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers For Medicare & Medicaid Services

[CMS-4055-N]


Medicare Program: National Medicare+Choice Risk Adjustment Public 
Meeting--February 3, 2003

AGENCY: Centers for Medicare & Medicaid Services (CMS), Health and 
Human Services.

ACTION: Notice of meeting.

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

SUMMARY: This notice announces a national Medicare+Choice risk 
adjustment public meeting for Medicare+Choice organizations, Medicare 
capitated demonstration projects, PACE plans, Evercare plans, Social 
Health Maintenance Organizations, Wisconsin Partnership program, 
Minnesota Senior Health Options, providers, practitioners, and other 
interested parties. The public meeting will provide updated information 
on the final CMS-HCC (Hierarchical Condition Category) risk adjustment 
model and risk adjustment data processing. This public meeting builds 
on information provided at the January 16, 2002 public meeting held at 
CMS, the draft model released on March 29, 2002, and the regional 
training sessions held in June 2002.

DATES: The public meeting is scheduled for February 3, 2003 from 9 a.m. 
until 5 p.m., e.s.t.

ADDRESSES: The public meeting will be held in the CMS Auditorium, 7500 
Security Boulevard, Baltimore, Maryland, 21244-1850.

FOR FURTHER INFORMATION CONTACT: Bobbie Knickman at (410) 786-4161 or 
[email protected]. To submit public comments no later than February 
18, 2003, 5 p.m., e.s.t., e-mail Angela Porter at [email protected] 
or fax to (410) 786-1048.

SUPPLEMENTARY INFORMATION:

Background

    The Balanced Budget Act of 1997 (BBA) (Pub. L. 105-33) expanded the 
Medicare+Choice (M+C) program for

[[Page 79123]]

Medicare beneficiaries. Under the BBA, the Secretary of Health and 
Human Services (the Secretary) was required to implement a risk 
adjustment methodology that adjusts M+C payments to account for 
variations in per capita costs based on health status and other 
demographic factors. The BBA also gave 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. The Secretary developed an initial risk adjustment methodology 
that incorporated only inpatient hospital data. As required by the BBA, 
this methodology was implemented beginning on January 1, 2000. 
Currently, only 10 percent of the M+C payment rate is risk adjusted 
under the existing risk adjustment methodology, with the other 90 
percent subject only to demographic adjustments. The Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 
(BIPA), enacted in December 2000, stipulates that the risk adjustment 
methodology for 2004 and succeeding years should be based on data from 
inpatient hospital and ambulatory settings. The BIPA also 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 balanced payment accuracy with data burden. We worked 
with M+C organizations, their associations, and other interested 
parties to develop a risk adjustment approach that significantly 
reduced the burden of data collection for M+C organizations compared to 
the approach that was suspended in May of 2001. The result of this 
effort was to reduce burden by approximately 98 percent. The reduction 
in burden was accomplished by decreasing the number of data elements 
submitted (from 50 to 5 elements), only requiring submission of 
diagnoses that are needed for calculating payments, and creating a 
simplified data submission format and processing system. The draft CMS-
HCC risk adjustment payment model was released on March 29, 2002. The 
CMS-HCC risk adjustment payment model is a 61 disease group selected 
significant disease model. Also released on March 29, 2002, was a file 
of ICD-9-CM codes required to group diagnosis codes for risk 
adjustment. On April 15, 2002, a reduced set of ICD-9-CM codes were 
released to further simplify the collection of diagnoses. The Risk 
Adjustment Processing System (RAPS) became operational on October 1, 
2002. Submission of ambulatory risk adjustment data (physician and 
hospital outpatient) resumed on October 1, 2002 for dates of service 
beginning July 1, 2002. On March 28, 2003 we will announce the proposed 
final version of the CMS-HCC risk adjustment payment model that affects 
risk adjustment payment beginning January 2004 and incorporates 
hospital inpatient, hospital outpatient and physician data.
    This public meeting will cover proposed changes to the draft 
version of the CMS-HCC risk adjustment model released on March 29, 
2002. These changes include proposed adjustments to account for higher 
costs for community-based enrollees, as well as proposed implementation 
approaches for 2004. The meeting will focus on the risk adjustment 
model and data collection and include the following topics:
    [sbull] Proposed final version of the CMS-HCC risk adjustment 
payment model.
    [sbull] Frailty adjuster (soliciting public comment).
    [sbull] Elimination of the lag between the data collection period 
and payment (soliciting public comment).
    [sbull] Risk adjustment data processing.
    [sbull] Risk adjustment schedule.
A copy of the public meeting agenda is available at: http://www.aspenxnet.com/meetingagenda.htm.
    The agenda will include presentations by CMS staff, Aspen training 
staff, as well as question and answer sessions. Written public comments 
are preferred following the meeting and will be accepted until February 
18, 2003, 5 p.m., e.s.t.

Registration

    Registration for this public meeting is required and will be on a 
first-come, first-serve basis, limited to three attendees per 
organization.
    This public meeting is intended for Medicare+Choice organizations, 
Medicare capitated demonstration projects, PACE plans, Evercare plans, 
Social Health Maintenance Organizations, Wisconsin Partnership program, 
Minnesota Senior Health Options, providers, practitioners, and other 
interested parties. A waiting list will be available for additional 
requests. The registration deadline is January 29, 2003 at 5 p.m., 
e.s.t. Registration must be completed via the Internet at the following 
Web site: http://www.aspenxnet.com/registration. A confirmation notice 
with specific meeting location information will be sent to attendees 
upon finalization of registration.
    Persons who are not registered in advance will not be permitted 
into the Federal Building and thus not be able to attend the public 
meeting. Persons attending the public meeting will be required to show 
photographic identification, preferably a valid driver's license, 
before entering the building. Please note that if the public meeting is 
cancelled, then a notice will be posted on our Web site (http://www.cms.hhs.gov).
    Attendees will be provided with meeting materials at the time of 
the meeting. Meeting materials will be available at http://www.mcoservice.com after February 3, 2003.
    Written questions about meeting logistics or requests for meeting 
materials after February 3, 2003 must be directed to: Kim Slaughter, 
Aspen Systems Corporation, Telephone Number: (301) 519-5388, Fax 
Number: (301) 519-6360, e-mail: [email protected].
    Written public comments will be accepted until February 18, 2003, 5 
p.m., e.s.t. Written public comments should be sent to Angela Porter at 
[email protected] or fax to (410) 786-1048.

    (Authority: Sections 1851 through 1859 of the Social Security 
Act (42 U.S.C. 1395w-21 through 1395w-28)) (Catalog of Federal 
Domestic Assistance Program No. 93.773 Medicare--Hospital Insurance 
Program; and No. 93.774, Medicare-- Supplementary Medical Insurance 
Program)

    Dated: December 4, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 02-31410 Filed 12-26-02; 8:45 am]
BILLING CODE 4120-01-P