[Federal Register Volume 70, Number 121 (Friday, June 24, 2005)]
[Notices]
[Pages 36613-36615]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-12524]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5022-N]


Medicare Program; Solicitation for Applications for the Medical 
Adult Day-Care Services Demonstration

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

ACTION: Notice for solicitation of applications.

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

SUMMARY: This notice informs interested parties of an opportunity to 
apply for participation in the Medical Adult Day-Care Services 
Demonstration. This demonstration tests an alternative approach to 
service delivery by allowing home health beneficiaries to receive a 
portion of the medical services included in their home health plan of 
care in a medical adult day-care facility (MADCF). The project will 
allow us to test potential improvements in quality

[[Page 36614]]

of care, outcomes, and program efficiency related to the provision of 
home health services in an MADCF setting. We intend to use a 
competitive application process to select up to five sites to 
participate in this demonstration. This demonstration is restricted to 
the States that license or certify medical adult day-care facilities.

FOR FURTHER INFORMATION AND TO OBTAIN A COPY OF THE SOLICITATION: 
Interested parties can obtain complete solicitation submission 
requirements and supporting information about this demonstration at the 
Medical Adult Day-Care Services Demonstration webpage found at the 
following Web site address: http://www.cms.hhs.gov/researchers/demos/MADCS/default.asp.
    Or by contacting: Armen Thoumaian, Ph.D., Mail Stop: S3-02-01, 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244. Phone: (410) 786-6672 or toll free at (877) 
267-2323, Ext. 66672. E-mail address: [email protected].

DATES: Effective Date: Applications must be received by September 22, 
2005.

ADDRESSES: Mail applications to--Centers for Medicare & Medicaid 
Services, Attention: Dr. Armen Thoumaian, Mail Stop: S3-02-01, 7500 
Security Boulevard, Baltimore, Maryland 21244. Because of staff and 
resource limitations, we cannot accept applications by facsimile (FAX) 
transmission or by e-mail. Applicants will receive a communication 
acknowledging the receipt of their application.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 703 of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA)(Pub. L. 108-173, enacted on December 8, 
2003) requires that the Secretary shall establish a demonstration 
project under which the Secretary shall, as part of a plan of care for 
home health services established for a Medicare beneficiary by a 
physician, permit a home health agency (HHA), directly or under 
arrangements with a medical adult day-care facility (MADCF), to provide 
medical adult day-care services as a substitute for a portion of home 
health services that would otherwise be provided in the beneficiary's 
home. Participation in the demonstration by Medicare beneficiaries 
admitted for home health care is voluntary. The demonstration is 
limited to not more than five sites and associated MADCF(s). Each site 
may include all States in which it provides home health services as 
long as the adult day-care services are provided in MADCFs licensed or 
certified in one of the States that license or certify medical adult 
day care facilities. Treatment under the 3-year demonstration is 
limited across all sites to 15,000 beneficiaries at any one time. For 
those Medicare beneficiaries who agree to participate in the 
demonstration, the HHA will receive 95 percent of the prospective 
payment system (PPS) amount that otherwise would have been paid for the 
home health episode of care had all services been delivered in the 
beneficiary's home.
    The purpose of this demonstration is to evaluate the outcomes and 
costs of providing innovative models of health care that include both 
home health care services and medical adult day-care services that 
improve the quality of life for Medicare beneficiaries. An independent 
evaluation will be conducted for this demonstration. At the conclusion 
of the demonstration, the Secretary must report to the Congress an 
evaluation of the clinical and cost-effectiveness of the demonstration 
as well as recommendations for the extension or termination of the 
project.

II. Purpose

    This notice solicits applications for a demonstration project in 
which Medicare-certified HHAs, in partnership with a medical adult day-
care facility (MADCF), or facilities, provide medical adult day-care 
services as a substitute for a portion of home health care services 
that would otherwise be provided in the beneficiary's home. The 
demonstration is initiated to determine whether these provisions will 
result in higher quality care with better utilization of Medicare-
covered services while promoting the physical and mental health of 
participating Medicare beneficiaries. The Medical Adult Day-Care 
Services Demonstration will allow a home health agency (directly or in 
conjunction with adult day health facilities) to provide a portion of 
the services included in the home health plan of care in a MADCF 
setting rather than in the beneficiary's home. As such, the 
demonstration will allow us to gather data on the efficacy and cost-
effectiveness of providing those services in the adult day health 
setting as an alternative to the home. Additional important outcomes 
from this demonstration project include: measuring impacts on the 
amounts and types of home health and other Medicare services 
beneficiaries receive and settings in which they receive them; 
utilization of other (non-Medicare covered) adult day health center 
services; beneficiary health, function, and satisfaction; family/
caregiver satisfaction; beneficiary out of pocket cost and total 
program costs; and HHA and MADCF financial outcomes. Most importantly, 
we can learn whether beneficiaries are willing to receive part of their 
home health services at an MADCF.

III. Site Selection

    Section 703 of the MMA provides that the Secretary shall conduct a 
three-year demonstration project in not more than five sites in States 
that license or certify providers of services that furnish medical 
adult day-care services. Potential sites are restricted to these 
states. The following 36 states have been identified as meeting this 
requirement: AK, AZ, CA, CO, DE, FL, HI, IA, KS, KY, LA, MA, ME, MD, 
MN, MO, MT, NE, NH, NJ, NV, NM, NC, NY, OK, PA, RI, SC, TN, TX, UT, VA, 
VT, WI, WV, WY. Applicants from states not listed must provide evidence 
that the state licenses or certifies providers of services that furnish 
medical adult day-care services.
    A demonstration site is defined as a single HHA or a corporate 
entity that includes one or more HHAs providing services in one or more 
of the eligible States. Pursuant to section 703(f) of the MMA, 
preference will be given to those agencies that are currently licensed 
or certified through common ownership and control to furnish medical 
adult day-care services according. We will require that all sites 
selected to participate in the demonstration be associated through 
ownership or through contractual agreement with one or more MADCFs. 
Sites will be selected based on the proposals that clearly and most 
convincingly address the issues set forth in the solicitation on our 
Web site: http://www.cms.hhs.gov/researchers/demos/MADCS/default.asp.
    Under the demonstration, the HHAs will be permitted to deliver (or 
contract for the delivery of) medical adult day-care services as a 
substitute for a portion of a beneficiary's home health care services 
at an affiliated MADCF that has been State licensed or certified for at 
least 2 years.

IV. Beneficiary Eligibility and Enrollment

    The demonstration will be open to all Medicare beneficiaries that 
meet the Medicare eligibility requirements for receiving home health 
care services through the Medicare fee-for-service program. 
Participation by Medicare beneficiaries in the demonstration is 
voluntary. Participating HHAs will

[[Page 36615]]

conduct patient assessments and other required activities as they 
normally would under the Medicare conditions of participation except 
that they would be able to offer Medicare home health patients the 
opportunity to receive a portion of their care in a MADCF. During the 
initial and follow-up patient assessments, HHAs will have the 
opportunity to identify beneficiaries who might benefit from adult day-
care services. Demonstration participants are those beneficiaries who 
agree to participate in the demonstration and receive part of their 
home health services at the MADCF. Those who agree should also be 
informed that they will be contacted in the future by the demonstration 
support and evaluation contractor(s).
    Participation by Medicare beneficiaries is completely voluntary and 
participating beneficiaries have the option of withdrawing from 
participation at any time. Up to 15,000 beneficiaries across the five 
sites may participate in the demonstration at any given time. Sites 
will be provided with enrollment limits proportional to their capacity 
prorated against the combined total of 15,000 enrollees at any one 
time. This will be done to ensure that smaller sites will have an 
opportunity to enroll a fair portion of the total enrollment allowed 
under the demonstration.

V. Payment

    Under the demonstration, the participating HHAs will be paid 95 
percent of the prospective payment system (PPS) amount that otherwise 
would have been paid for the home health episode of care had all 
services been delivered in the beneficiary's home. Current provisions 
related to case-mix group assignment and payment adjustments are not 
affected by the demonstration. Payment will be provided directly to the 
HHA for all services delivered during the home health episode of care 
whether provided at home or in the adult day health facility. Under 
section 703(b)(1) of the MMA, the beneficiary may not be separately 
charged for medical adult-day care services furnished as part of the 
home health plan of care.
    The statute requires the Secretary to monitor the demonstration to 
ensure that the provision of services in the demonstration does not 
result in a net increase in total spending, and provides the authority 
to make payment adjustments to ensure that budget neutrality is 
maintained.

VI. Collection of Information Requirements

    The information collection requirements associated with this notice 
are subject to the Paperwork Reduction Act of 1995 (PRA); however, the 
collection is currently approved under OMB control number 0938-0880 
entitled ``Medicare Demonstration Waiver Application'' with a current 
expiration date of July 31, 2006.

    Authority: Section 703 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-173.

    Dated: April 29, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-12524 Filed 6-23-05; 8:45 am]
BILLING CODE 4121-01-P