[Federal Register Volume 70, Number 179 (Friday, September 16, 2005)]
[Notices]
[Pages 54751-54752]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-18144]



[[Page 54751]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5017-N]


Medicare Program; Medicare Health Care Quality (MHCQ) 
Demonstration Programs

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

ACTION: Notice.

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SUMMARY: This notice informs eligible health care groups of an 
opportunity to apply to participate in the Medicare Health Care Quality 
demonstration. The goal of the demonstration is to improve the quality 
of care and services delivered to Medicare beneficiaries through a 
major system redesign that fosters best practice guideline usage, 
continuous quality and patient safety improvement, shared decision 
making between providers and patients, and the delivery of culturally 
and ethnically appropriate care. This notice contains information on 
how to obtain the complete solicitation and supporting information.
    A competitive process will be used to select 8 to 12 health care 
organizations (that is, physician group practices, integrated delivery 
systems, and regional coalitions of physician group practices and 
integrated delivery systems) to participate in the 5-year 
demonstration. The application solicitation will be conducted in two 
phases.

DATES: For the initial solicitation, applications will be considered if 
received at the appropriate address, provided in the ADDRESSES section, 
no later than 5 p.m. e.s.t., on January 30, 2006. For the second 
solicitation phase, applications will be considered if we receive them 
no later than 5 p.m. e.d.t., on September 29, 2006. Applicants 
intending to submit a proposal for the second phase review should 
forward a letter of intent to the same address listed in the ADDRESSES 
section of this notice, no later than January 30, 2006.

Letter of Intent Requirements: The letter of intent should include the 
following:
     An outline of the demonstration proposal.
     A description of the proposed organizational structure.
     A timeline for development and implementation of the 
proposed model.
     A projected or desired date for submission of the 
application.
    This will enable us to--
    1. Better plan for the second phase of the solicitation;
    2. Keep prospective applicants apprised of any new developments 
over the course of the solicitation process; and
    3. Ensure that they have the latest information for preparing their 
applications.

ADDRESSES: Mail or deliver applications to the following address: 
Centers for Medicare & Medicaid Services, Attention: Cynthia Mason, 
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: Cynthia Mason at (410) 786-6680 or 
[email protected]. Interested parties can obtain complete solicitation 
and supporting information on the CMS Web site at http://www.cms.hhs.gov/researchers/demos/mma646/. Paper copies can be obtained 
by writing to Cynthia Mason at the address listed in the ADDRESSES 
section of this notice.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 646 of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) (Pub. L. 108-173) amends title XVIII 
(42 U.S.C. 1395 et seq.) of the Social Security Act (the Act) by 
establishing the Medicare Health Care Quality (MHCQ) Demonstration 
Programs. The MHCQ demonstration will test major changes to improve 
quality of care while increasing efficiency across an entire health 
care system. Broadly stated, the goals of the Medicare Health Care 
Quality demonstration are to--
     Improve patient safety;
     Enhance quality;
     Increase efficiency; and
     Reduce scientific uncertainty and the unwarranted 
variation in medical practice that results in both lower quality and 
higher costs.
    The legislation anticipates that we can facilitate these 
overarching goals by providing incentives for system redesigns built on 
adoption and use of decision support tools by physicians and their 
patients, such as evidence-based medicine guidelines, best practice 
guidelines, and shared decision-making programs; reform of payment 
methodologies; measurement of outcomes; and enhanced cultural 
competence in the delivery of care.

II. Provisions of This Notice

    The MHCQ demonstration will test the ability of health care groups 
to implement major system changes that reallocate resources to improve 
quality and reduce costs of Medicare Parts A, B, and C. Each proposal 
is expected to address all of the Institute of Medicine's ``Six Aims 
for Improvement.'' The proposed system redesign should:
     Include steps to improve patient safety in the delivery of 
care,
     Increase the effectiveness of the health care delivered, 
minimizing the over- and under-utilization of services Through the use 
of best practice guidelines and other measures,
     Prioritize patient-centeredness in the delivery of care 
with primary focus on patients' needs and comfort, Including increased 
emphasis on patient education and development of self-care skills,
     Improve the timeliness of care, significantly reducing 
delay in the delivery of needed health care services,
     Emphasize ways of improving efficiency in care delivery 
and thus improving quality, and
     Assure equity of care for all persons.

Further, we are persuaded that such system redesign should include the 
integration of health information technology consistent with the 
national health information infrastructure strategy and that--
     Informs clinical practice;
     Interconnects clinicians;
     Personalizes health care; and
     Improves population health.
    We intend to use this demonstration to identify, develop, test, and 
disseminate major and multi-faceted improvements to the entire health 
care system. The focus will be on redesign projects that ``bundle'' 
multiple delivery improvements so as to introduce ``system-ness'' 
across the spectrum of care delivery--changes across and even between 
organizations. The redesign must make the system patient-focused and 
must undo the effects of a payment methodology that systematically 
fragments care while encouraging both omissions and duplication of 
care. At its ``grandest,'' particularly if a demonstration project is 
conducted by a regional coalition and entails the participation of 
other payers besides Medicare, this demonstration affords us and the 
awardees an opportunity to reinvent the health care delivery system.
    In keeping with our view that this demonstration authority is 
intended to test models of basic health care system redesign, including 
payment reform, we note that the statute provides broad authority for 
us to waive both payment and non-payment provisions of the Medicare 
program. Therefore, we are

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not specifying particular models of health care systems that 
demonstration applicants must propose and test, but are looking to 
applicants to specify the models they believe they can successfully put 
into practice for the patients they serve in their communities.
    As provided by applicable Federal statute, physician groups, 
integrated delivery systems, and organizations representing regional 
coalitions of physician groups or integrated delivery systems are 
eligible to apply. Integrated delivery systems must include a full 
range of health care providers including hospitals, clinics, home 
health agencies, ambulatory surgery centers, skilled nursing 
facilities, rehabilitation facilities and clinics, and employed, 
independent or contracted physicians. Eligible organizations and 
coalitions may form a new corporate entity for the purpose of 
representing provider organizations or eligible organizations may 
designate an existing entity as their representative. However, the 
entity organizing the coalition and developing the demonstration 
proposal must be an eligible provider organization.
    Payments under the MHCQ demonstration will be made for services 
furnished to Medicare beneficiaries and will be tied to cost savings, 
as well as improvements in process and outcome measures, increases in 
efficiencies, and reductions in costs in the targeted population 
compared to a similar group or sample. Eligible organizations may 
propose a variety of payment methodologies as long as those 
methodologies are amenable to an evaluation methodology based upon 
Medicare claims data. In addition, all proposals must assure budget 
neutrality and no duplication of payments for existing Medicare 
benefits. We will not be providing funding for start-up or other costs.

III. Collection of Information Requirements

    This information collection requirement is 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 646 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA).

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

    Dated: May 19, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-18144 Filed 9-9-05; 8:45 am]
BILLING CODE 4120-01-P