[Federal Register Volume 76, Number 98 (Friday, May 20, 2011)]
[Notices]
[Pages 29249-29250]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-12383]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5501-N]
Medicare Program; Pioneer Accountable Care Organization Model:
Request for Applications
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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[[Page 29250]]
SUMMARY: This notice announces a request for applications for
organizations to participate in the Pioneer Accountable Care
Organization Model for a period beginning in 2011 and ending December
2016.
DATES: Letter of Intent Submission Deadline: Interested organizations
must submit a nonbinding letter of intent by June 10, 2011 as described
on the Innovation Center Web site http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco.
Application Submission Deadline: Applications must be received on
or before July 19, 2011.
ADDRESSES: Applications should be submitted by mail to the following
address by the date specified in the DATES section of this notice:
Pioneer ACO Model, Attention: Maria Alexander, Center for Medicare and
Medicaid Innovation, Centers for Medicare and Medicaid Services, Mail
Stop S3-13-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
FOR FURTHER INFORMATION CONTACT: [email protected] for questions
regarding the aspects of the Pioneer Accountable Care Organization
Model or the application process.
SUPPLEMENTARY INFORMATION:
I. Background
We are committed to achieving the three-part aim of better health,
better health care, and lower per-capita costs for Medicare, Medicaid,
and Childrens' Health Insurance Program beneficiaries. One potential
mechanism for achieving this goal is for CMS to partner with groups of
health care providers of services and suppliers with a mechanism for
shared governance that have formed an Accountable Care Organization
(ACO) through which they work together to manage and coordinate care
for a specified group of patients. We will pursue such partnerships
through two complementary efforts--the Medicare Shared Savings Program
and initiatives undertaken by the Center for Medicare and Medicaid
Innovation (Innovation Center). The Pioneer ACO Model is an Innovation
Center initiative targeted at organizations that can demonstrate the
improvements in financial and clinical performance with respect to the
care of Medicare beneficiaries that are possible in a mature ACO. To be
eligible to participate in the Pioneer ACO Model, organizations would
ideally already be coordinating care for a significant portion of
patients under financial risk sharing contracts and be positioned to
transform both their care and financial models from fee-for-service to
a three-part aim, value based model. This notice provides a general
overview of the Pioneer ACO Model. For more details see the request for
application which is available on the Innovation Center Web site at
http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco.
II. Provisions of the Notice
Consistent with its authority under section 1115A of the Social
Security Act (of the Act), as added by section 3021 of the Affordable
Care Act, to test innovative payment and service delivery models that
reduce spending under Medicare, Medicaid, or CHIP, while preserving or
enhancing the quality of care, the Innovation Center aims to achieve
the following goals through implementation of the Pioneer ACO Model:
Test a more rapid transition for providers from volume
based FFS payments to payment for coordination and outcomes.
Promote a diversity of successful ACOs, including
physician-led ACOs and those serving indigent or rural populations.
This Model will test the effectiveness of a combination of the
following:
Payment arrangements that place a group of providers at
joint risk for quality performance and financial performance for the
majority of their patients and revenues (including non-Medicare
patients and revenues). Such payment arrangements will require
participants to transition from fee-for-service to population-based
payment by the third performance year. We believe the payment
arrangements being tested will provide more opportunities for rapid
escalation of shared savings and risk compared to the Medicare Shared
Savings Program.
Technical support in the form of rapid data feedback and
shared learning activities.
Size and scope of testing: We expect to partner with
approximately 30 organizations in the Model, with a minimum of 15,000
Medicare beneficiaries each (5,000 for rural ACOs). The application
process and selection criteria are described in Section IV of the
Request for Applications but in general, applications will be
prioritized based on the strength of their care improvement plans,
leadership, and commitment to outcomes-based contracts with non-
Medicare purchasers. Final selection will be based on the strength of
the application and interviews of finalists, together with other
factors to promote representation of diverse geographic areas, types of
organizations, and types of Medicare populations served.
Population: ACOs will be accountable for all fee-for-
service Medicare beneficiaries that CMS determines are aligned with
them, and who have continuous enrollment in Parts A and B during
baseline and performance periods, with emphasis on encouraging care of
underserved populations and dual eligibles.
Duration: Between 5 and 6 years (start third or fourth
quarter of 2011 and end December 2016, which includes two 1-year
optional periods).
III. Collection of Information Requirements
Section 1115A(d) of the Act waives the requirements of the
Paperwork Reduction Act of 1995 for the Innovation Center for purposes
of testing new payment and service delivery models.
Authority: Section 1115A of the Social Security Act.
Dated: March 10, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-12383 Filed 5-17-11; 8:45 am]
BILLING CODE 4120-01-P