[Federal Register Volume 79, Number 144 (Monday, July 28, 2014)]
[Notices]
[Pages 43747-43749]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-17625]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3296-NC]
RIN 0938-ZB14


Medicare Program; Evaluation Criteria and Standards for 
Beneficiary and Family Centered Care Quality Improvement Organization 
Contract

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

ACTION: Notice with comment period.

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SUMMARY: This notice with comment period describes the general criteria 
we intend to use to evaluate the effectiveness and efficiency of 
Beneficiary and Family Centered Care (BFCC) Quality Improvement 
Organizations (QIOs) that will enter into contracts with CMS under the 
11th Statement of Work (SOW) in May 2014 titled, ``Beneficiary and 
Family Centered Care (BFCC) Quality Improvement Organization (QIO) 
Contract'' (HHSM-500-2014-RFP-BFCC-QIO). This contract allows for a 
transition period from the incumbent QIOs to the successor QIOs. The 
activities for the BFCC-QIO SOW begin August 1, 2014. The evaluation of 
a BFCC-QIO's performance related to the SOW will be based on evaluation 
criteria specified for the tasks set forth in Attachment J-10 of the 
BFCC-QIOs' SOW contract.

DATES: Effective Date: August 1, 2014 to July 31, 2019.
    Comment Date: To be assured consideration, comments must be 
received at one of the addresses provided below, no later than 5 p.m. 
on August 27, 2014.

ADDRESSES: In commenting, refer to file code CMS-3296-NC. Because of 
staff and resource limitations, we cannot accept comments by facsimile 
(FAX) transmission.
    You may submit comments in one of four ways (please choose only one 
of the ways listed):
    1. Electronically. You may submit electronic comments on this 
regulation to http://www.regulations.gov. Follow the ``Submit a 
comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address ONLY: Centers for Medicare & Medicaid Services, Department of 
Health and Human Services, Attention: CMS-3296-NC, P.O. Box 8010, 
Baltimore, MD 21244-1850.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the following address ONLY: Centers for Medicare & Medicaid Services, 
Department of Health and Human Services, Attention: CMS-3296-NC, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    4. By hand or courier. Alternatively, you may deliver (by hand or 
courier) your written comments ONLY to the following addresses:
    a. For delivery in Washington, DC--Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, Room 445-G, Hubert 
H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201

(Because access to the interior of the Hubert H. Humphrey Building 
is not readily

[[Page 43748]]

available to persons without Federal government identification, 
commenters are encouraged to leave their comments in the CMS drop 
slots located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by 
stamping in and retaining an extra copy of the comments being 
filed.)

    b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    If you intend to deliver your comments to the Baltimore address, 
call telephone number (410) 786-9994 in advance to schedule your 
arrival with one of our staff members.
    Comments erroneously mailed to the addresses indicated as 
appropriate for hand or courier delivery may be delayed and received 
after the comment period.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Alfreda Staton, (410) 786-4194.

SUPPLEMENTARY INFORMATION:
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following Web 
site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to 
view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.

I. Background

    Section 1153(h)(2) of the Social Security Act (the Act) requires 
the Secretary of the Department of Health and Human Services to publish 
in the Federal Register the general criteria and standards that will be 
used to evaluate the effective and efficient performance of contract 
obligations by the Quality Improvement Organizations (QIOs) and to 
provide the opportunity for public comment with respect to these 
criteria and standards. This notice describes the general criteria that 
will be used to evaluate the performance of Beneficiary and Family 
Centered Care (BFCC) Quality Improvement Organizations (QIOs) under the 
11th Statement of Work (SOW) contract beginning August 1, 2014.

II. Provisions of the Notice With Comment Period

    The purpose of the BFCC-QIO contract is to improve healthcare 
services for Medicare beneficiaries through BFCC performance of 
numerous statutory and regulatory review functions, including, but not 
limited to the following:
     Quality of care reviews, including beneficiary complaint 
reviews and general quality of care reviews;
     Beneficiary appeals of hospital discharges and 
terminations of service decisions, commonly referred to as Grijalva, 
BIPA, and Weichardt appeals.
     Medical necessity reviews;
     Appropriateness of setting reviews;
     Diagnosis Related Group (DRG) reviews;
     Readmission reviews;
     Reviews under Emergency Medical Treatment and Active Labor 
Act (EMTALA);
     Sanctions; and
     Monitoring of Physician Acknowledgement Statements under 
section 1156(a) of the Act and our regulations at 42 CFR 412.46.
    The BFCC-QIO contract also imposes other BFCC-QIO responsibilities: 
Coordinating and collaborating with other QIOs; developing and making 
recommendations to promote responsiveness to beneficiary and family 
needs; providing opportunities for listening to and addressing 
beneficiary and family concerns; and providing resources for 
beneficiaries and caregivers in decision making. These QIO beneficiary 
and family centered efforts align with the National Quality Strategy, 
which encourages patient and family engagement. (See the BFCC-QIO 
Statement of Work, Solicitation Number: HHSM-500-2014-RFP-BFCC-QIO, 
which was posted on December 5, 2013 and is available at https://www.fbo.gov/index?s=opportunity&mode=form&id=6a3acf7d9bd34efb1268e120a13b22e8.)

III. Evaluation of the Tasks (See Sections C.6, H.2, H.5 and J-10 of 
the BFCC-QIO SOW)

    We will conduct monitoring activities throughout the course of the 
contract and will act upon findings as necessary. Information used for 
these monitoring purposes includes but is not limited to:
     Deliverables submitted by the BFCC-QIO to CMS in 
accordance with the Section F ``Deliverables or Performance.''
     Provider/facility surveys and/or productivity measures, 
including cost benefit analysis.
     Data for measures indicated in Attachments J-4 and J-10 of 
the BFCC-QIO SOW.
     Data from the BFCC-QIO's Internal Quality Control Program.
     Other data submitted by BFCC-QIOs as required by CMS.
     Additional information gathered by email, telephone, video 
or in-person visits.
    BFCC-QIOs must cooperate with the Contracting Officer 
Representative (COR) on all our monitoring processes and address any 
concerns identified by the COR. We will take appropriate contract 
action (for example, providing warning for the need for adjustment, 
instituting a formal correction plan, terminating an activity, or 
recommending early termination of a contract because of failure to meet 
contract timelines or performance as specified in the contract). This 
means that the BFCC-QIO must comply with the Contract, Tasks, Schedules 
of Deliverables, Evaluation Measures Tables, and any subsequent 
modifications (including Health Care Quality Improvement System and 
Transmission of Policy Memorandums) issued by CMS.
    Additionally, there will be multiple periods of more formal 
evaluation under this contract. The first evaluation will occur at the 
end of the 12th month of the contract. Subsequent evaluations will 
occur at the end of the 24, 36, 48 and 54th month of the contract. The 
evaluations will be based on the most recent data available to us. The 
performance results of the evaluation at each evaluation period (that 
is, 12, 24, 36, 48 and 54th months) will be used, in addition to 
ongoing monitoring activities, to determine the BFCC-QIO's performance 
on the overall contract.
    The BFCC-QIO measures for the 11th SOW are as follows:
     Quality of Review: Inter-Rater Reliability.
     4-day Data Entry Compliance.
     Timeliness of Beneficiary Complaints and Other Quality of 
Care Reviews.
     Timeliness of Discharge/Service Termination Reviews.
     Timeliness of EMTALA and Higher Weighted Diagnosis-Related 
Group Reviews.
     Complainant Agreement to Complete Survey.
     Beneficiary Experience with Quality of Care Complaints.
     Beneficiary Experience with Appeal Reviews.

[[Page 43749]]

Annual and 54th Month Evaluation

    Annual and 54th month evaluation criteria are specifically defined 
in Attachment J-10, ``Annual and 54th Month Evaluation Criteria 
Measures Table,'' of the BFCC-QIO SOW; the criteria for evaluating each 
deliverable are identified in Section F (``Deliverables or 
Performance'') of the 11th SOW. Further, the Contracting Officer will 
use the Contractor Performance Assessment Reporting System (CPARS) 
criteria in performing evaluations: Quality, Schedule/Timeliness, Cost/
Price Control, Business Relations, Management, and Small Business. 
Performance on the evaluation criteria defined in Attachment J-10 will 
be considered for assessment of the Quality sub-factor for the CPARS 
assessment.

Overall Contract Evaluation

    The results of the annual (12, 24, 36, 48th month) and 54th month 
evaluation periods, in addition to ongoing monitoring activities, will 
be used to determine how the contractor performed on the overall 
contract. If we choose, we may notify the BFCC-QIO of our intention not 
to renew the BFCC-QIO contract and inform the BFCC-QIO of their rights 
under the current statute.
    Any failure at one or more of the annual or 54th month evaluations 
for any Task may result in the BFCC-QIO receiving an adverse past 
performance evaluation. Further, failure may impact on the BFCC-QIO's 
ability to continue similar work in or eligibility for future QIO 
Program awards.
    We reserve the right at any point, prior to the notification of our 
intent not to renew the contract, to revise measures or adjust the 
expected minimum thresholds for satisfactory performance or remove 
criteria from a Task evaluation protocol for any reason, including, but 
not limited to, data gathered based on experience with the amount of 
improvement achieved during the contract cycle or in pilot projects 
currently in progress, information gathered through evaluation of the 
BFCC-QIO performance overall, or any unforeseen circumstances. Further, 
in accordance with standard contract procedures, we reserve the right 
at any time to discontinue all or part of one or more Tasks for one or 
more states or territories in the QIO area or any other part of this 
contract, regardless of BFCC-QIO performance on the Task.

IV. Collection of Information Requirements

    This document 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.

V. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document, we will respond to the 
comments in the preamble to that document.

VI. Regulatory Impact Statement

    In accordance with the provisions of Executive Order 12866, this 
notice was not reviewed by the Office of Management and Budget.

    Dated: June 3, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2014-17625 Filed 7-25-14; 8:45 am]
BILLING CODE 4120-01-P