[Federal Register Volume 81, Number 242 (Friday, December 16, 2016)]
[Notices]
[Pages 91174-91175]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-30269]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5521-N]


Medicare Program; Start-Up Funding in Support of the Vermont All-
Payer Accountable Care Organization (ACO) Model--Cooperative Agreement

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

ACTION: Notice.

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SUMMARY: The purpose of this notice is to announce issuance of the 
November 23, 2016 single-source cooperative agreement funding 
opportunity available solely to Vermont's Agency of Human Services in 
order to provide care coordination and bolster collaboration for 
practices and community-based health care providers as part of the 
Vermont All[dash]Payer Accountable Care Organization (ACO) Model.

DATES: The performance period of the Vermont All-Payer ACO Model will 
begin on January 1, 2017, and conclude on December 31, 2022.

FOR FURTHER INFORMATION CONTACT: Stephen Cha, (410) 786-1876.

SUPPLEMENTARY INFORMATION:

I. Background

    The Vermont All-Payer Accountable Care Organization Model (Model) 
is the Centers for Medicare & Medicaid Services' (CMS) new test within 
the Center for Medicare and Medicaid Innovation of an alternative 
payment model in which the major health care payers--Medicare, 
Medicaid, and commercial health care payers--incentivize health care 
value and quality under the same payment structure for health care 
providers throughout the state's care delivery system to transform 
health care for the entire state and its population. An Accountable 
Care Organization (ACO) is an entity formed by certain health care 
providers that accepts financial accountability for the overall quality 
and cost of medical care furnished to, and health of, beneficiaries 
attributed to the entity.
    CMS believes that states can be critical partners of the federal 
government and other health care payers to facilitate the design, 
implementation, and evaluation of community-centered health systems 
that can deliver significantly improved cost, quality, and population 
health performance results for all state residents, including Medicare, 
Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries. 
States have policy and regulatory authorities, as well as ongoing 
relationships with commercial healthcare payers, health plans, and 
health care providers that can accelerate delivery system reform. CMS 
has previously partnered with states to accelerate delivery system 
reform through initiatives such as the State Innovations Model (SIM). 
SIM provides state-based healthcare transformation efforts with funding 
to test the ability of states to utilize policy and regulatory levers 
to accelerate multi-payer health care transformation.
    Vermont, a SIM state awardee, approached CMS with a desire to 
include Medicare in the state's multipayer payment and care delivery 
model, and Vermont publicly released its proposal on January 25, 2016. 
CMS reviewed Vermont's proposal and determined that it met the 
necessary requirements to explore a potential Vermont-specific model in 
which Medicare aligns with Vermont's healthcare transformation efforts. 
In October 2016, CMS and the State of Vermont entered into the Vermont 
All-Payer Accountable Care Organization Model Agreement (``State 
Agreement'') to implement the Vermont All-Payer ACO Model. The Vermont 
All-Payer ACO Model will be a 6-year model beginning in 2017 and ending 
in 2022.
    As part of the Model, Vermont health care providers will 
participate in a Vermont-specific Medicare ACO initiative (the Vermont 
Medicare ACO Initiative), which is largely based on CMS' Next 
Generation ACO Model. CMS will provide one-time start-up funding in the 
amount of $9,500,000 to the State to assist Vermont health care 
providers with care coordination and bolster their collaboration with 
community-based resources. CMS will provide the start-up funding as a 
cooperative agreement funding opportunity available solely to Vermont's 
Agency of Human Services, as announced in this notice. More information 
about the Vermont All-Payer ACO Model can be found at https://innovation.cms.gov/initiatives/vermont-all-payer-aco-model/.
    Through the Model, CMS will test whether the quality of health care 
for Vermont residents improves and healthcare expenditures for 
beneficiaries across payers (including Medicare fee-for-service, 
Vermont Medicaid, Vermont commercial plans, and Vermont self-insured 
plans) decrease if--
     The aforementioned payers offer Vermont ACOs risk-based 
arrangements tied to health outcomes and healthcare expenditures;
     The majority of Vermont health care providers enter into 
such risk-based arrangements; and
     The majority of Vermont residents across payers are 
aligned to an ACO bound by these arrangements.
    CMS and Vermont aim for broad ACO participation throughout the 
state, across all the significant payers and the majority of the care 
delivery system, to make redesigning the entire care delivery system a 
rational business strategy for Vermont health care providers and 
payers. As set forth in the State Agreement, Vermont commits to 
achieving statewide health outcomes, financial targets, and ACO scale 
(percentage of Vermont residents

[[Page 91175]]

aligned to an ACO) targets--both for Medicare and across all 
significant healthcare payers. Additionally, CMS and Vermont aim for 
this Model to deliver meaningful improvements in the health of a 
state's entire population by transforming the relationships between and 
amongst care delivery and public health systems across Vermont.

II. Provisions of the Notice

    The purpose of this notice is to announce a single source 
cooperative agreement funding opportunity in the amount of $9,500,000 
available solely to Vermont's Agency of Human Services (AHS) to support 
care coordination and bolster collaboration for practices and 
community-based health care providers as part of the Vermont 
All[dash]Payer ACO Model. A single-source award to the AHS will enable 
CMS to provide assistance to Vermont for the following purposes: To 
connect Medicare fee-for-service beneficiaries with community-based 
resources, coordinate transitions across care settings with appropriate 
involvement of the Medicare fee-for-service beneficiaries' primary care 
providers, coordinate care across health care providers, support health 
promotion and self-management by Medicare fee-for-service 
beneficiaries, and support practice improvement and transformation. 
These activities are necessary for Vermont to achieve the health 
outcomes and financial goals required under the Vermont All-Payer ACO 
Model.
    CMS and Vermont believe the Vermont All-Payer ACO Model can support 
health care providers, including physicians in small practices, to 
succeed as health care moves from fee-for-service to value-based 
payment systems. Participation by health care providers and payers in 
the model will be voluntary, and CMS and Vermont expect to work closely 
together to achieve sufficient uptake. In particular, this Model is 
being implemented using the Secretary's authority in section 1115A of 
the Social Security Act (the Act) and Vermont's Global Commitment to 
Health demonstration project authorized under section 1115 of the Act. 
Together these authorities make it possible for physicians and other 
clinicians in Vermont to participate the aligned and state-specific 
Vermont Medicare ACO Initiative and Medicaid ACO initiative. Under the 
Quality Payment Program, the two-sided risk portion of the Vermont 
Medicare ACO Initiative meets the criteria to be an Advanced 
Alternative Payment Model. Health care providers participating in the 
two-sided risk portion of the Vermont Medicare ACO Initiative may 
potentially qualify for the APM Incentive Payments starting in 
performance year 2018.
    This single-source funding opportunity to the AHS is designed to 
meet the goals of the cooperative agreement based on the AHS' existing 
knowledge and role in supporting the Model, its existing partnerships 
and collaborations with Vermont health care providers, and its 
resources and ability to deploy the funding immediately.

III. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).

    Dated: December 6, 2016.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2016-30269 Filed 12-15-16; 8:45 am]
 BILLING CODE 4120-01-P