[Federal Register Volume 78, Number 25 (Wednesday, February 6, 2013)]
[Notices]
[Pages 8535-8536]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-02194]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5506-N]


Medicare Program: Comprehensive End-Stage Renal Disease Care 
Model Announcement

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

ACTION: Notice.

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SUMMARY: This notice announces a request for applications from 
organizations to participate in the testing of the Comprehensive End-
Stage Renal Disease (ESRD) Care Model, a new initiative from the Center 
for Medicare and Medicaid Innovation (Innovation Center), for a period 
beginning in 2013 and ending in 2016, with a possible extension into 
subsequent years.

DATES: Letter of Intent Submission Deadline: Interested organizations 
must submit a non-binding letter of intent on or before March 15, 2013.
    Application Submission Deadline: Applications must be received on 
or before May 1, 2013.

 FOR FURTHER INFORMATION CONTACT:
    Daniel Farmer, (410) 786-5497 or Email [email protected].

SUPPLEMENTARY INFORMATION:

I. Background

    The Center for Medicare and Medicaid Innovation (Innovation 
Center), within the Centers for Medicare & Medicaid Services (CMS), was 
created to develop and test innovative health care payment and service 
delivery models that show promise of reducing program expenditures, 
while preserving or enhancing the quality of care for Medicare, 
Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries.
    We are interested in identifying models designed to improve care 
for specific populations. One population is beneficiaries with end-
stage renal disease (ESRD). This population has complex health care 
needs, typically with comorbid conditions and disease complications, 
which require extensive care coordination services. To promote seamless 
and integrated care for beneficiaries with ESRD, a comprehensive care 
delivery model would emphasize coordination of a full-range of clinical 
and non-clinical services across providers, suppliers, and settings. 
This may be best achieved through the establishment of an 
interdisciplinary care team that is led by a nephrologist, comprised of 
dialysis facilities, health care professionals, paraprofessionals, and 
non-traditional health providers.
    Through the Comprehensive ESRD Care Model, we seek to identify ways 
to improve the coordination and quality of care for this population, 
while lowering total per-capita expenditures to the Medicare program. 
We anticipate that the Comprehensive ESRD Care Model would result in 
improved health outcomes for beneficiaries with ESRD regarding the 
functional status, quality of life, and overall well-being, as well as 
increased beneficiary and caregiver engagement, and lower costs to 
Medicare through improved care coordination.

II. Provisions of the Notice

    Section 1115A of the Social Security Act (the Act), as added by 
section 3021 of the Affordable Care Act, authorizes the Innovation 
Center to test innovative payment and service delivery models that 
reduce spending under Medicare, Medicaid or CHIP, while preserving or 
enhancing the quality of care. Under this authority, we seek to test 
whether establishing new incentives for dialysis facilities, 
nephrologists, and other healthcare providers and suppliers to improve 
the care delivered to Medicare beneficiaries living with ESRD will 
result in better outcomes through the implementation of the 
Comprehensive ESRD Care Model.
    Under the Comprehensive ESRD Care Model, CMS will enter shared 
financial risk arrangements through ``Participation Agreements'' with 
organizations comprised of dialysis facilities, nephrologists, and 
other Medicare providers and suppliers. Participating organizations 
will be clinically and financially accountable for care provided to a 
group of beneficiaries with ESRD that will be attributed to these 
organizations based on the beneficiaries' historical and ongoing care 
patterns. Those organizations that are successful in improving 
beneficiary outcomes and lowering per capita Medicare Parts A and B 
expenditures will be able to share in Medicare savings generated. 
However, those organizations that do not improve outcomes and lower 
costs may be subject to losses. Final shared savings amounts and shared 
loss amounts will be based on the organization's performance on 
specified quality measures.
    Organizations interested in applying to participate in the testing 
of the Comprehensive ESRD Care Model must submit a non-binding letter 
of intent and an application. Applications will not be accepted from 
organizations that did not submit a letter of intent. The letter of 
intent and application must be received by the dates specified in the 
DATES section of this notice.
    For additional information on the Comprehensive ESRD Care Model and 
how to apply, click on the Request for Applications located on the 
Innovation Center Web site at: innovation.cms.gov/initiatives/comprehensive-ESRD-care.

III. Collection of Information Requirements

    Section 1115A(d)(3) of the Act, as added by section 3021 of the 
Affordable Care Act, states that Chapter 35 of title 44, United States 
Code (the Paperwork Reduction Act of 1995), shall not apply to the 
testing and evaluation of models or expansion of such models under this 
section. Consequently, it need not be reviewed by the Office of 
Management and Budget under the authority of the Paperwork Reduction 
Act of 1995.

[[Page 8536]]

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

    Dated: January 25, 2013.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2013-02194 Filed 2-4-13; 4:15 pm]
BILLING CODE 4120-01-P