[Federal Register Volume 76, Number 245 (Wednesday, December 21, 2011)]
[Pages 79193-79194]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-32568]



Centers for Medicare & Medicaid Services


Medicare Program; Independence at Home Demonstration Program

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

ACTION: Notice.


SUMMARY: This notice creates a new demonstration program for 
chronically ill Medicare beneficiaries to test a payment incentive and 
service delivery system that utilizes physician and nurse practitioner 
directed home-based primary care teams aimed at improving health 
outcomes and reducing expenditures, beginning December 21, 2011.

DATES: Effective Date: This notice is effective on December 21, 2011.
    Application Deadline: February 6, 2012 at 5 p.m., Eastern Standard 
Time (E.S.T.).

Linda Colantino (410) 786-3343.
Jennifer Brown (410) 786-4036.


I. Background

    Section 3024 of the Patient Protection and Affordable Care Act of 
2010 (the Affordable Care Act) (Pub. L. 111-148, enacted on March 23, 
2010), amends title XVIII of the Social Security Act (the Act) by 
establishing the Independence at Home (IAH) Demonstration.
    The IAH Demonstration will test a service delivery model that 
utilizes physician and nurse practitioner directed primary care teams 
to provide services to high cost, chronically ill Medicare 
beneficiaries in their homes. Participating practices will be 
accountable for providing comprehensive, coordinated, continuous, and 
accessible care to high-need populations at home and coordinate health 
care across all treatment settings. Participating practices may share 
in savings under the demonstration if specified quality measures and 
savings targets are achieved.

II. Provisions of the Notice

    We are seeking interested practices that can provide home-based 
primary care to Medicare beneficiaries for purposes of this 
demonstration. We anticipate that a wide variety of interested 
practices may be eligible to apply to the IAH Demonstration. The 
participants in the Demonstration will be multidisciplinary teams 
composed of various members such as physicians, nurse practitioners, 
physician assistants, pharmacists, social workers, and other supporting 
staff. The practices must be led by physicians or nurse practitioners 
and must have experience providing home-based primary care to patients 
with multiple chronic illnesses. These practices will also be 
organized, at least in part, for the purpose of providing physician 
services. Qualifying practices may share in savings. Providers cannot 
be participating in section 1899 of the Act, the Medicare Shared 
Savings Program, or other Medicare shared savings programs at the time 
of the Demonstration.
    Each participating practice must provide services to at least 200 
applicable beneficiaries during each year of the demonstration. A 
practice's enrollment may vary over each year but must reach at least 
an average of 200 applicable beneficiaries during the first year and 
not drop below that average for the remainder of the demonstration. 
There are three options available for practices to apply for the 
Demonstration. Practices may apply as a sole legal entity, consortium, 
or become a part of a national pool. These three options are for the 
purpose of establishing expenditure targets and determining incentive 
payments. Practices must enroll all existing patients meeting 
beneficiary eligibility criteria.
    Participating practices will make in-home visits tailored to an 
individual patient's needs. Each practice must be available 24 hours 
per day, 7 days a week to carry out plans of care. Practices must use 
electronic health information systems, remote monitoring, and mobile 
diagnostic technology.
    Applicable beneficiaries are defined as Medicare fee-for-service 
(FFS) patients, who have at least 2 chronic illnesses, need assistance 
with 2 or more functional dependencies requiring the assistance of 
another person, have had a nonelective hospital admission within the 
last 12 months, and have received acute or subacute rehabilitation 
services within the last 12 months. Beneficiaries to be included in the 
Demonstration must be entitled to Medicare part A and enrolled in 
Medicare part B, not enrolled in a Medicare Advantage plan or a Program 
for All-Inclusive Care for the Elderly, and cannot be enrolled in a 
practice that is part of the Medicare Shared Savings Program or other 
program that shares Medicare savings.
    We will establish a practice-specific spending target derived from 
claims, based on expected Medicare FFS utilization for each of the 
beneficiaries in the practices in the absence of the Demonstration. 
Annual spending targets will be calculated for each participating 
practice at the end of each performance year. The spending target will 
be derived from a base expenditure amount equal to the average payments 
under Medicare Part A and Part B. Savings will be calculated as the 
difference between each practice's spending target and actual costs. 
Practices will also be required to meet quality performance standards 
in order to share in any savings. Under this 3-year demonstration, IAH 
providers will continue to bill and be paid standard Medicare FFS 
    Applicants must submit completed applications following the format 
outlined in the Demonstration application instructions in order to be 
considered for review by CMS. Applications not received in this format 
will not be considered for review.
    For the Project Application and specific details regarding the IAH 
Demonstration, please refer to the CMS Web site at http://www.cms.gov/

[[Page 79194]]

    Please refer to file code [CMS-5048-N] on the Application. 
Applicants must submit at least 1 electronic copy on CD-ROM of the 
Application and are required to submit a paper version of the 
Application with an original signature. Because of staffing and 
resource limitations, we cannot accept applicationss by facsimile (FAX) 
transmission. Hard copies and electronic copies must be identical.
    Applications for practices applying to the IAH Demonstration will 
be considered timely if they are received on or before 5 p.m., Eastern 
Standard Time (E.S.T.) on the date listed in the DATES section of this 

III. Collection of Information Requirements

    Accordance to section 3024 of the Affordable Care Act this notice 
does not impose information collection and recordkeeping requirements. 
Consequently, it need not be reviewed by the Office of Management and 
Budget under the authority of the Paperwork Reduction Act of 1995 (44 
U.S.C. 35).

    Authority:  Section 3024 of the Affordable Care Act.

(Catalog of Federal Domestic Assistance Program No. 93.778, 
Medicare--Supplementary Medical Insurance Program)

    Dated: September 9, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-32568 Filed 12-20-11; 8:45 am]