[Federal Register Volume 79, Number 23 (Tuesday, February 4, 2014)]
[Notices]
[Pages 6594-6596]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-02062]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5511-N]


Medicare and Medicaid Programs; Solicitation for Proposals for 
the Frontier Community Health Integration Project Demonstration

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

ACTION: Notice.

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SUMMARY: This notice provides eligible entities with the information 
necessary to apply for participation in the Frontier Community Health 
Integration Project (FCHIP) demonstration. The demonstration is 
designed to better integrate the delivery of acute care, extended care 
and other health care services, and improve access to care for Medicare 
and Medicaid beneficiaries residing in very sparsely populated areas. A 
competitive application process will be used to select eligible 
entities for participation in this demonstration. The demonstration is 
planned for up to 3 years.

DATES: Applications will be considered timely if we receive them on or 
before 5 p.m., eastern standard time (E.S.T.) on May 5, 2014.

ADDRESSES: Mail one unbound original and two copies to: Centers for 
Medicare & Medicaid Services, Attention: Steven Johnson, 7500 Security 
Boulevard, Mail Stop: WB-06-05, Baltimore, Maryland 21244-1850.
    In addition, an email copy in MS Word or PDF must be sent to: 
[email protected].

FOR FURTHER INFORMATION CONTACT: Steven Johnson, (410) 786-3332 or 
[email protected].

[[Page 6595]]


SUPPLEMENTARY INFORMATION: Please refer to file code CMS-5511-N on the 
application. Applicants are required to submit one unbound original and 
two copies to the address listed in the ADDRESSES section of this 
notice. In addition, an email copy in MS Word or PDF must be sent to: 
[email protected]. Because of staffing and resource limitations, we 
cannot accept applications by facsimile (FAX) transmission. 
Applications postmarked after the closing date, or postmarked on or 
before the closing date but not received in time, will be considered 
late.

I. Background

A. Legislative Authority

    Section 123 of the Medicare Improvements for Patients and Providers 
Act of 2008, (MIPPA) (Pub. L. 110-275) as amended by section 3126 of 
the Patient Protection and Affordable Care Act (Pub. L. 111-148), 
authorizes a demonstration project on community health integration 
models in certain rural counties to develop and test new models for the 
delivery of health care services to better integrate the delivery of 
acute care, extended care and other health care services, and improve 
access to care for Medicare and Medicaid beneficiaries residing in very 
sparsely populated areas.
    The authorizing legislation defines distinct roles for this 
demonstration for the Centers for Medicare & Medicaid Services (CMS) 
and the Health Resources and Services Administration (HRSA) in 
developing and implementing this project. HRSA was charged with 
awarding grants to eligible entities for the purpose of technical 
assistance and informing the Secretary of the Department of Health and 
Human Services (Secretary) on the specific needs of frontier 
communities, while CMS is to conduct a demonstration testing 
alternative reimbursement and administrative strategies.
    This demonstration is commonly known as the Frontier Community 
Health Integration Project (FCHIP). CMS is hereby requesting 
applications for participation in this demonstration from eligible 
entities as defined in Section 123(d)(1)(B) of MIPPA. CMS interprets 
the eligible entity definition as meaning critical access hospitals 
(CAHs) that receive funding through the Rural Hospital Flexibility 
Program. The statute limits the Demonstration to no more than 4 States; 
it also restricts eligibility to CAHs within States with at least 65 
percent of counties with 6 or less persons per square mile. With 
respect to these requirements, CMS is limiting applications to CAHs in 
Alaska, Montana, Nevada, North Dakota, and Wyoming.
    The authorizing legislation mandates that the project last for 3 
years. The law authorizes waiver of such provisions of the Medicare and 
Medicaid programs as are necessary to conduct the demonstration 
project. The authorizing legislation also requires the demonstration to 
be budget neutral, that is, to be structured such that Medicare 
expenditures under the demonstration do not to exceed the amount which 
the Secretary estimates would have been paid if the demonstration 
project were not implemented. This notice references CMS's request for 
proposals for the FCHIP demonstration, which sets forth project 
guidelines, conditions of participation, payment methodology, and 
application instructions.
    The FCHIP demonstration is designed to improve access to certain 
services, the delivery of which is often not feasible at low volumes 
under current Medicare reimbursement but if integrated into the local 
delivery system, would lead to improved outcomes and greater efficiency 
in health care service delivery. Integration of services is intended as 
an intervention that is directed by the various providers serving the 
community so that the specific health care needs of residents are 
addressed in appropriate settings--either inpatient, outpatient, or at 
home. The desired outcome is to increase access to health care 
services, with the objective of supporting certain services so as to 
allow them to be financially feasible given the low patient volumes of 
a remote and sparsely populated area. Another objective is to decrease 
the number of avoidable hospital admissions, readmissions, and 
avoidable transfers to tertiary facilities, such that there is no net 
increase in Medicare spending for the affected population. To address 
the goal of increasing access with no net cost increase, we have 
identified four types of services for which this demonstration will 
provide financial support, and promote community health integration--
these are: Nursing facility care within the CAH, telemedicine, 
ambulance, and home health. We have selected these services on the 
basis of research and literature review. Applicants should identify 
additional services of one or more of these types, beyond what is 
currently available. Applicants must address the need for these 
services, including how they enhance patient care options and the 
ability of beneficiaries to remain in their communities; and how 
quality of these services will be maintained, to assure care can safely 
be provided locally. We will also work in the development process of 
this project with State Medicaid agencies on their proposals for 
Medicaid-specific reimbursement mechanisms to support access to 
community-based health care services.

B. FCHIP Applications

    In keeping with the authorizing legislation in section 123 of 
MIPPA, entities that meet the eligibility requirements will be able to 
apply for the demonstration. Specifically, an eligible entity must be 
located in either Alaska, Montana, Nevada, North Dakota, or Wyoming 
although CMS will select no more than 4 States to participate in the 
demonstration. Each entity in its application will be required to 
describe a proposal to enhance health-related services so as to 
complement those currently provided within the community and reimbursed 
by Medicare, Medicaid, or other third-party payers. The applicant must 
describe an integrated system of services and explain how these will 
better serve the community's health-related needs.
    An entity applying for the demonstration will be required to 
demonstrate linkages (either ownership or contractual) with the 
providers of the identified additional services, such as nursing home, 
telemedicine, home health agency, or ambulance service. Specifically, 
to be approved for payment of telemedicine services under the 
demonstration's payment methodology, the applicant must demonstrate 
effective arrangements with distant site specialists who will 
participate in telemedicine linkages with providers within the 
communities. In addition, to be approved for ambulance services, the 
applicants must show transfer arrangements with essential providers.
    Each applicant will be asked to submit an analysis of how its 
proposed project will be budget neutral and/or achieve cost savings. 
This will include projections of the number of patients that will gain 
access to services within the community that are supported by the 
demonstration, the cost of these services, and the resulting cost 
savings from averting transfers to out-of-area hospitals and/or 
avoidable hospitalizations. The applicant will be evaluated on the 
plausibility of this analysis, the ability to support projections with 
clinical evidence and the sensitivity of cost outcomes to the stated 
assumptions of change in services and patient behavior.
    Interested and eligible parties can obtain complete solicitation 
and supporting information on the CMS

[[Page 6596]]

Web site at: http://innovation.cms.gov/initiatives/index.html. Paper 
copies can be obtained by writing to Steven Johnson at the address 
listed in the ADDRESSES section of this notice.

II. Collection of Information Requirements

    The information collection requirements associated with this notice 
are subject to the Paperwork Reduction Act of 1995; however, the 
information collection requirements are currently approved under the 
information collection request associated with OMB control number 0938-
0880 entitled ``Medicare Waiver Demonstration Applicant.'' Applicants 
must submit the Medicare Waiver Demonstration Application to be 
considered for this program.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: August 20, 2013.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2014-02062 Filed 1-31-14; 4:15 pm]
BILLING CODE 4120-01-P