[Federal Register Volume 70, Number 66 (Thursday, April 7, 2005)]
[Notices]
[Pages 17697-17698]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-6861]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5029-N]


Medicare Program; Rural Hospice Demonstration

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

ACTION: Notice.

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SUMMARY: This notice provides interested parties with the information 
necessary to apply for participation in the rural hospice 
demonstration. The demonstration is designed to test whether hospice 
services provided by a demonstration hospice program to Medicare 
beneficiaries who lack an appropriate caregiver and who reside in rural 
areas results in wider access, improved hospice services, benefits to 
the rural community, and a sustainable pattern of care. A competitive 
application process will be used to select up to three hospice 
organizations or agencies to participate in this demonstration. The 
demonstration is planned for up to 5 years.

DATES: Applications will be considered timely if we receive them on or 
before June 6, 2005.

ADDRESSES: Mail applications to--Centers for Medicare & Medicaid 
Services, Attention: Cindy Massuda, Mail Stop: C4-17-27, 7500 Security 
Boulevard, Baltimore, Maryland 21244.
    Because of staff and resource limitations, we cannot accept 
applications by facsimile (FAX) transmission or by e-mail.

FOR FURTHER INFORMATION CONTACT: Cindy Massuda at (410) 786-0652 or 
[email protected].

SUPPLEMENTARY INFORMATION:

I. Background

A. Legislative Authority

    Section 409 of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) (Pub. L. 108-173) authorizes the 
Secretary to conduct a demonstration project for the delivery of 
hospice care to Medicare beneficiaries in rural areas. Under the 
demonstration, Medicare beneficiaries who are unable to receive hospice 
care

[[Page 17698]]

at home for lack of an appropriate caregiver are provided care in a 
facility of 20 or fewer beds that offers, within its walls, the full 
range of services provided by hospice programs under section 1861(dd) 
of the Social Security Act (42 U.S.C. 1395x(dd)).
    Under the demonstration project, the hospice program shall comply 
with otherwise applicable requirements, except that it shall not be 
required to offer services outside of the hospice facility or to meet 
the requirements of section 1861(dd)(2)(A)(iii) of the Social Security 
Act (SSA) regarding the 20-percent cap on inpatient care days.
    The Secretary may require the hospice demonstration to comply with 
additional quality assurance standards for provision of services. Upon 
completion of the project, the Secretary shall submit a report to the 
Congress on the project including recommendations regarding extensions 
to hospice programs serving rural areas.

B. The Rural Hospice Demonstration

    The demonstration will be offered to up to three hospice programs 
and will not exceed a period of 5 years. The demonstration is designed 
to test whether hospice services provided by a demonstration hospice 
program to Medicare beneficiaries who lack an appropriate caregiver and 
who reside in rural areas results in wider access, improved hospice 
services, benefits to the rural community, and a sustainable pattern of 
care. Hospice provides palliative care to individuals who have a 
terminal illness with a prognosis of 6 months or less. The care is 
provided typically in the individual's home or place of residence with 
family members present. Individuals who lack family or someone to serve 
as the primary caregiver need proportionately more support from hospice 
staff. Due to long distances and difficult terrain, it can be 
particularly difficult to provide the Medicare hospice benefit 
efficiently in rural areas. There may be situations where the hospice 
benefit could be provided to beneficiaries who would not otherwise be 
able to receive these services if the location of hospice care is 
altered. This demonstration will allow a hospice with up to 20 beds to 
provide all levels of hospice services within its walls to individuals 
who reside in rural areas and lack an appropriate caregiver, while not 
having to provide services outside of the hospice facility or comply 
with the 20-percent cap on inpatient care days.
    While the demonstration provider will not have to meet the limit on 
inpatient care days or provide care outside of the facility, it will 
not alter the level of care requirements for general inpatient care. In 
order to provide general inpatient care to hospice patients, a hospice 
participating in the demonstration must assure that the need for 
general inpatient care is met according to Medicare guidelines. The 
demonstration will test whether hospice services provided by a facility 
that does not meet the limit on inpatient care days or provide services 
outside of the facility for hospice individuals residing in rural areas 
who lack an appropriate caregiver results in wider access, improved 
hospice services, benefits to the rural community, and a sustainable 
pattern of care.
    The demonstration is designed for a demonstration hospice to 
provide the full range of services within its facility to Medicare 
beneficiaries who reside in rural areas and lack an appropriate 
caregiver. If a demonstration hospice provides care to any patient who 
either lives outside a rural area or has an appropriate caregiver, then 
the hospice must comply with all of Medicare hospice requirements at 
1861(dd) of the SSA for these patients since they are not considered 
part of the demonstration.
    We plan to make up to three awards. Interested parties can obtain 
complete solicitation and supporting information on the CMS Web site 
at: http://www.cms.hhs.gov/researchers/demos/rmbh/default.asp. Paper 
copies can be obtained by writing to Cindy Massuda at the address 
listed in the ADDRESSES section of this notice.

II. Collection of Information Requirements

    Since CMS will receive less than 10 applications to this 
solicitation, the information collection requested reference in this 
solicitation are not subject to the PRA as stipulated under 5 CFR 
1320.3(c).

    Authority: Section 409 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173).

(Domestic Assistance No. 93.773 Medicare--Hospital insurance 
Program; and No. 93.774, Medicare-Supplementary Medical Insurance 
Program)

    Dated: March 10, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-6861 Filed 4-1-05; 4:42 pm]
BILLING CODE 4120-01-P