95-30066. New and Pending Demonstration Project Proposals Submitted Pursuant to Section 1115(a) of the Social Security Act: August and September 1995

[Federal Register Volume 60, Number 237 (Monday, December 11, 1995)]
[Notices]
[Pages 63532-63536]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-30066]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[ORD-081-N]


New and Pending Demonstration Project Proposals Submitted 
Pursuant to Section 1115(a) of the Social Security Act: August and 
September 1995

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice.

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SUMMARY: This notice lists new proposals for Medicaid demonstration 
projects submitted to the Department of Health and Human Services 
during the months of August and September 1995 under the authority of 
section 1115 of the Social Security Act. This notice also lists 
proposals that were approved, disapproved, pending, or withdrawn during 
this time period. (This notice can be accessed on the Internet at 
HTTP://WWW.SSA.GOV/HCFA/HCFAHP2.HTML.)

COMMENTS: We will accept written comments on these proposals. We will, 
if feasible, acknowledge receipt of all comments, but we will not 
provide written responses to comments. We will, however, neither 
approve nor disapprove any new proposal for at least 30 days after the 
date of this notice to allow time to receive and consider comments. 
Direct comments as indicated below.

ADDRESSES: Mail correspondence to: Susan Anderson, Office of Research 
and Demonstrations, Health Care Financing Administration, Mail Stop C3-
11-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.

FOR FURTHER INFORMATION CONTACT: Susan Anderson, [phone].

SUPPLEMENTARY INFORMATION:

I. Background

    Under section 1115 of the Social Security Act (the Act), the 
Department of Health and Human Services (HHS) may consider and approve 
research and demonstration proposals with a broad range of policy 
objectives. These demonstrations can lead to improvements in achieving 
the purposes of the Act.
    In exercising her discretionary authority, the Secretary has 
developed a number of policies and procedures for reviewing proposals. 
On September 27, 1994, we published a notice in the Federal Register 
(59 FR 49249) that specified (1) The principles that we ordinarily will 
consider when approving or disapproving demonstration projects under 
the authority in section 1115(a) of the Act; (2) the procedures we 
expect States to use in involving the public in the development of 
proposed demonstration projects under section 1115; and (3) the 
procedures we ordinarily will follow in reviewing demonstration 
proposals. We are committed to a thorough and expeditious review of 
State requests to conduct such demonstrations.
    As part of our procedures, we publish a notice in the Federal 
Register with a monthly listing of all new submissions, pending 
proposals, approvals, disapprovals, and withdrawn proposals. Proposals 
submitted in response to a grant solicitation or other competitive 
process are reported as received during the month that such grant or 
bid is awarded, so as to prevent interference with the awards process.

II. Listing of New, Pending, Approved, and Withdrawn Proposals for the 
Months of August and September 1995

A. Comprehensive Health Reform Programs

1. New Proposals
    No new proposals were received during the month of August.
    The following comprehensive health reform proposals were received 
during the month of September. 

[[Page 63533]]

    Demonstration Title/State: The Georgia Behavioral Health Plan--
Georgia.
    Description: Georgia proposes to provide behavioral health services 
under a managed care system through the section 1115 demonstration. The 
plan would be implemented by regional boards that would contract with 
third party administrators to develop a network of behavioral health 
providers. The currently eligible Medicaid population would be enrolled 
in the program and would have access to a full range of behavioral 
health services. Once the program realizes savings, the State proposes 
to expand coverage to individuals who become newly eligible.
    Date Received: September 1, 1995.
    State Contact: Margaret Taylor, Coordinator for Strategic Planning, 
Department of Medical Assistance, 1 Peachtree Street NW., Suite 27-100, 
Atlanta, GA 30303-3159, [phone].
    Federal Project Officer: Nancy Goetschius, Health Care Financing 
Administration Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
    Demonstration Title/State: State of Texas Access Reform (STAR)--
Texas.
    Description: Texas is proposing a section 1115 demonstration that 
will restructure the Medicaid program using competitive managed care 
principles. A focal point of the proposal is to utilize local 
governmental entities (referred to as Intergovernmental Initiatives 
(IGIs)) and to make the IGI responsible for designing and administering 
a managed care system in its region. Approximately 876,636 new 
beneficiaries would be served during the 5-year demonstration in 
addition to the current Medicaid population. Texas proposes to 
implement the program in June 1996.
    Date Received: September 6, 1995.
    State Contract: Cathy Rossberg, State Medicaid Office, P.O. Box 
13247, Austin, TX 78711, [phone].
    Federal Project Officer: Alisa Adamo, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
2. Pending Proposals
    Demonstration Title/State: Better Access for You (BAY) Health Plan 
Demonstration--Alabama.
    Description: Alabama proposes to create a mandatory managed care 
delivery system in Mobile County for non-institutionalized Medicaid 
beneficiaries and an expansion population of low-income women and 
children. The network, called the Bay Health Network, would be 
administered by the PrimeHealth Organization, which is owned by the 
University of South Alabama Foundation. The State also proposes to 
expand family planning benefits for pregnant women whose income is less 
than 133 percent of the Federal poverty level.
    Date Received: July 10, 1995.
    State Contact: Vicki Huff, Director, Managed Care Division, Alabama 
Medicaid Agency, PO. Box 5624, Montgomery, AL 36103-5624, (334) 242-
5011.
    Federal Project Officer: Maria Boulmetis, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Arizona Health Care Cost Containment 
System (AHCCCS)--Arizona.
    Description: Arizona proposes to expand eligibility under its 
current section 1115 AHCCCS program to individuals with incomes up to 
100 percent of the Federal poverty level.
    Date Received: March 17, 1995.
    State Contact: Mabel Chen, M.D., Director, Arizona Health Care Cost 
Containment System, 801 East Jefferson, Phoenix, AZ 85034, (602) 271-
4422.
    Federal Project Officer: Joan Peterson, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: MediPlan Plus--Illinois.
    Description: Illinois seeks to develop a managed care delivery 
system using a series of networks, either local or statewide, to tailor 
its Medicaid delivery system to the needs of local urban neighborhoods 
or large rural areas.
    Date Received: September 15, 1994.
    State Contact: Tom Toberman, Manager, Federal/State Monitoring, 201 
South Grand Avenue East, Springfield, IL 62763, [phone].
    Federal Project Officer: Gina Clemons, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Community Care of Kansas--Kansas.
    Description: Kansas proposes to implement a ``managed cooperation 
demonstration project'' in four predominantly rural counties, and to 
assess the success of a non-competitive managed care model in rural 
areas. The demonstration would enroll persons currently eligible in the 
Aid to Families with Dependent Children (AFDC) and AFDC-related 
eligibility categories, and expand Medicaid eligibility to children 
ages 5 and under with family incomes up to 200 percent of the Federal 
poverty level.
    Date Received: March 23, 1995.
    State Contact: Karl Hockenbarger Kansas Department of Social and 
Rehabilitation Services, 915 Southwest Harrison Street, Topeka, KS 
66612, [phone].
    Federal Project Officer: Jane Forman, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-21-
04, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Kentucky Health Care Partnership--
Kentucky.
    Description: Kentucky proposes to enroll all non-institutional 
AFDC, AFDC-related, and aged, blind, and disabled Medicaid-eligible 
individuals in regional managed care networks operated by a sole-source 
contractor. The proposed start date of the demonstration is December 1, 
1995.
    Date Received: June 19, 1995.
    State Contact: Larry A. McCarthy, Director, Program Development and 
Budget, Department of Medicaid Services, 275 East Main Street, 
Frankfort, KY 40621, [phone].
    Federal Project Officer: Maria Boulmetis, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850,
    Demonstration Title/State: Louisiana Health Access--Louisiana.
    Description: Louisiana proposes to implement a fully capitated 
statewide managed care program. A basic benefit package and a 
behavioral health and pharmacy wrap-around would be administered 
through the managed care plans. The State intends to expand Medicaid 
eligibility to persons with incomes up to 250 percent of the Federal 
poverty level; those with incomes above 133 percent of the Federal 
poverty level would pay all or a portion of premiums.
    Date Received: January 3, 1995.
    State Contact: Carolyn Maggio, Executive Director, Bureau of 
Research and Development, Louisiana Department of Health and Hospitals, 
P.O. Box 2870, Baton Rouge, LA 70821-2871, [phone].
    Federal Project Officer: Gina Clemons, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850,
    Demonstration Title/State: Missouri.
    Description: Missouri proposes to require Medicaid beneficiaries to 
enroll in managed care delivery systems, and extend Medicaid 
eligibility to persons with incomes below 200 percent of the 

[[Page 63534]]
Federal poverty level. As part of the program, Missouri would create a 
fully capitated managed care pilot program to serve non-
institutionalized persons with permanent disabilities on a voluntary 
basis.
    Date Received: June 30, 1994.
    State Contact: Donna Checkett, Director, Division of Medical 
Services, Missouri Department of Social Services, P.O. Box 6500, 
Jefferson City, MO 65102-6500, [phone].
    Federal Project Officer: Nancy Goetschius, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: The Granite State Partnership for Access 
and Affordability in Health Care--New Hampshire.
    Description: New Hampshire proposes to extend Medicaid eligibility 
to adults with incomes below the AFDC cash standard and to create a 
public insurance product for low-income workers. The State also seeks 
to implement a number of pilot initiatives to help redesign its health 
care delivery system.
    Date Received: June 14, 1994.
    State Contact: Barry Bodell, New Hampshire Department of Health and 
Human Services, Office of the Commissioner, 6 Hazen Drive, Concord, NH 
03301-6505, [phone].
    Federal Project Officer: Maria Boulmetis, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: The Partnership Plan--New York.
    Description: New York proposes to move most of the currently 
eligible Medicaid population and Home Relief (General Assistance) 
populations from a primarily fee-for-service system to a managed care 
environment. The State also proposes to establish special needs plans 
to serve individuals with HIV/AIDS and certain children with mental 
illnesses. The proposed enrollment date for Home Relief and AFDC 
recipients is November 1, 1995, followed by a 1-year enrollment period 
for the supplemental security income (SSI) population beginning January 
1, 1997.
    Date Received: March 17, 1995.
    State Contact: Richard T. Cody, Deputy Commissioner, Division of 
Health and Long Term Care, 40 North Pearl Street, Albany, NY 12243, 
[phone].
    Federal Project Officer: Debbie Van Hoven, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: SoonerCare--Oklahoma.
    Description: Oklahoma proposes to implement a 5-year statewide 
managed care demonstration using both fully and partially capitated 
delivery systems. The emphasis of the program is to address access 
problems in rural areas by encouraging the development of rural-based 
managed care initiatives. The State will employ traditional fully 
capitated managed care delivery models for urban areas and will 
introduce a series of partial capitation models in the rural areas of 
the State. All currently eligible, non-institutionalized Medicaid 
beneficiaries will be enrolled during the first 2 years of the project.
    Date Received: January 6, 1995.
    State Contact: Dr. Garth Splinter, Oklahoma Health Care Authority, 
Lincoln Plaza, 4545 North Lincoln Blvd., Suite 124, Oklahoma City, OK 
73105, [phone].
    Federal Project Officer: Helaine I. Fingold, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Section 1115 Demonstration Waiver for 
Medicaid Expansion--Utah.
    Description: Utah proposes to expand eligibility for Medicaid to 
all individuals with incomes up to 100 percent of the Federal poverty 
level (subject to limited cost sharing) and to enroll all Medicaid 
beneficiaries in managed care plans. The State also proposes to 
streamline eligibility and administrative processes and to develop a 
subsidized small employer health insurance plan.
    Date Received: July 5, 1995.
    State Contact: Michael Deily, Acting Division Director, Utah 
Department of Health, Division of Health Care Financing, 288 North 1460 
West, P.O. Box 142901, Salt Lake City, UT 84114-2901, [phone].
    Federal Project Officer: David Walsh, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
3. Approved Conceptual Proposals (Awards of Waivers Pending)
    No conceptual proposals were approved during the months of August 
and September.
4. Approved Grant Proposals (Award of Waivers Pending)
    No grant proposals were awarded during the months of August and 
September.
5. Approved Proposals
    No proposals were approved during the months of August and 
September.
6. Disapproved Proposals
    No comprehensive health reform proposals have been disapproved 
since January 1, 1993.
7. Withdrawn Proposals
    No comprehensive health reform proposals were withdrawn during the 
months of August and September.

B. Other Section 1115 Demonstration Proposals

1. New Proposals
    No new proposals were received during the month of August.
    The following proposal was received during the month of September:
    Demonstration/Title: Integrated Care and Financing Project 
Demonstration--Colorado.
    Description: Colorado proposes to conduct an Integrated Care and 
Financing Project demonstration. Specifically, the Colorado Department 
of Health Care Policy and Financing proposes to add institutional and 
community-based long-term care services to a health maintenance 
organization (HMO) and make the HMO responsible for providing 
comprehensive medical and supportive services through one capitated 
rate. The project would include all Medicaid eligibility groups, 
including individuals with dual eligibility.
    Date Received: September 28, 1995.
    State Contact: Dann Milne, Office of Long-Term Care System 
Development, State of Colorado Department of Health Care Policy and 
Financing, 1575 Sherman Street, Denver, CO 80203-1714, [phone].
    Federal Contact: Melissa McNiff, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
2. Pending Proposals.
    Demonstration Title/State: Alternatives in Medicaid Home Care 
Demonstration--Colorado.
    Description: Colorado proposes to conduct a pilot project that 
eliminates the restriction on provision of Medicaid home health 
services in locations other than the beneficiary's place of residence. 
The proposal would also 

[[Page 63535]]
permit nursing aides to perform functions that historically have been 
provided only by skilled nursing staff. Medicaid beneficiaries 
participating in the project will be adults (including both frail 
elderly clients and younger clients with disabilities) who can live 
independently and self-direct their own care. The project would provide 
for delegation of specific functions from nurses to certified nurses 
aides, pay nurses for shorter supervision and monitoring visits, and 
allow higher payments to aides performing delegated nursing tasks. 
Currently, home health agency nursing and nurse aide services are paid 
on a per visit basis. Each visit is approximately 2-4 hours in 
duration, and recipients must require skilled, hands-on care.
    Date Received: June 3, 1995.
    State Contact: Dann Milne, Director, Department of Health Care 
Policy and Financing, 1575 Sherman Street, Denver, CO 80203-1714, (303) 
866-5912.
    Federal Project Officer: Phyllis Nagy, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-21-
06, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Georgia's Children's Benefit Plan--
Georgia.
    Description: Georgia submitted a section 1115 proposal entitled 
``Georgia Children's Benefit Plan'' to provide preventive and primary 
care services to children aged 1 through 5 living in families with 
incomes between 133 percent and 185 percent of the Federal poverty 
level. The duration of the project is 5 years with proposed project 
dates of July 1, 1995 to June 30, 2000.
    Date Received: December 12, 1994.
    State Contact: Jacquelyn Foster-Rice, Georgia Department of Medical 
Assistance, 2 Peachtree Street Northwest, Atlanta, GA 30303-3159, (404) 
651-5785.
    Federal Project Officer: Maria Boulmetis, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: High Cost User Initiative--Maryland.
    Description: Maryland proposes to implement an integrated case 
management system for high-cost, high-risk Medicaid beneficiaries.
    Date Received: July 8, 1994.
    State Contact: John Folkemer, Maryland Department of Health and 
Mental Hygiene, Office of Medical Assistance Policy, 201 West Preston 
Street, Baltimore, MD 21201, [phone].
    Federal Project Officer: William Clark, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-21-
06, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Family Planning Services Section 1115 
Waiver Request--Michigan.
    Description: Michigan seeks to extend Medicaid eligibility for 
family planning services to all women of childbearing age with incomes 
at or below 185 percent of the Federal poverty level, and to provide an 
additional benefit package consisting of home visits, outreach services 
to identify eligibility, and reinforced support for utilization of 
services. The duration of the project is 5 years.
    Date Received: March 27, 1995.
    State Contact: Gerald Miller, Director, Department of Social 
Services, 235 South Grand Avenue, Lansing, MI 48909, [phone].
    Federal Project Officer: Suzanne Rotwein, Ph.D., Health Care 
Financing Administration, Office of Research and Demonstrations, Mail 
Stop C3-24-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Montana Mental Health Access Plan--
Montana.
    Description: Montana proposes to provide all mental health services 
for current Medicaid-eligible individuals through managed care and to 
expand Medicaid eligibility to persons with incomes up to 200 percent 
of the Federal poverty level. Newly eligible individuals would receive 
only mental health benefits, and would not be eligible for other health 
services under the demonstration. A single statewide contractor would 
provide the mental health services and also determine eligibility, 
perform inspections, and handle credentialing.
    Date Received: June 16, 1995.
    State Contact: Nancy Ellery, State Medicaid Director, Department of 
Social and Rehabilitation Services, P.O. Box 4210, 111 North Sanders, 
Helena, MT 59604-4210, [phone].
    Federal Project Officer: Nancy Goetschius, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Family Planning Proposal--New Mexico.
    Description: New Mexico proposes to extend Medicaid eligibility for 
family planning services to all women of childbearing age with incomes 
at or below 185 percent of the Federal poverty level.
    Date Received: November 1, 1994.
    State Contact: Bruce Weydemeyer, Director, Division of Medical 
Assistance, P.O. Box 2348, Santa Fe, NM 87504-2348, [phone].
    Federal Project Officer: Suzanne Rotwein, Ph.D., Health Care 
Financing Administration, Office of Research and Demonstrations, Mail 
Stop C3-24-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: CHOICES--Citizenship, Health, 
Opportunities, Interdependence, Choices and Supports--Rhode Island.
    Description: Rhode Island proposes to consolidate all current State 
and Federal funding streams for adults with developmental disabilities 
under one program using managed care/managed competition.
    Date Received: April 5, 1994.
    State Contact: Susan Babin, Department of Mental Health, 
Retardation, and Hospitals, Division of Developmental Disabilities, 600 
New London Avenue, Cranston, RI 02920, [phone].
    Federal Project Officer: Melissa McNiff, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-21-
06, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Family Planning Services Eligibility 
Requirements Waiver--South Carolina.
    Description: South Carolina proposes to extend Medicaid coverage 
for family planning services for 22 additional months to postpartum 
women with monthly incomes under 185 percent of the Federal poverty 
level. The objectives of the demonstration are to increase the number 
of reproductive age women receiving either Title XIX or Title X funded 
family planning services following the completion of a pregnancy, 
increase the period between pregnancies among mothers eligible for 
maternity services under the expanded eligibility provisions of 
Medicaid, and estimate the overall savings in Medicaid spending 
attributable to providing family planning services to women for 2 years 
postpartum. The duration of the proposed project would be 5 years.
    Date Received: May 4, 1995.
    State Contact: Eugene A. Laurent, Executive Director, State Health 
and Human Services Finance Commission, P.O. Box 8206, Columbia, SC 
29202-8206, [phone].
    Federal Project Officer: Suzanne Rotwein, Ph.D., Health Care 
Financing Administration, Office of Research and Demonstrations, Mail 
Stop C3-24-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Demonstration Title/State: Wisconsin. 
    
[[Page 63536]]

    Description: Wisconsin proposes to limit the amount of exempt funds 
that may be set aside as burial and related expenses for SSI-related 
Medicaid beneficiaries.
    Date Received: March 9, 1994.
    State Contact: Jean Sheil, Division of Economic Support, Wisconsin 
Department of Health and Social Services, 1 West Wilson Street, Room 
650, P.O. Box 7850, Madison, WI 53707, [phone].
    Federal Project Officer: J. Donald Sherwood, Health Care Financing 
Administration, Office of Research and Demonstrations, Mail Stop C3-16-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850.
3. Approved Conceptual Proposals (Award of Waivers Pending)
    No conceptual proposals were awarded during the months of August 
and September.
4. Approved Proposals
    No proposals were approved during the months of August and 
September.
5. Disapproved Proposals
    No proposals were disapproved during the months of August and 
September.
6. Withdrawn Proposals
    No proposals were withdrawn during the months of August and 
September.

IV. Requests for Copies of a Proposal

    Requests for copies of a specific Medicaid proposal should be made 
to the State contact listed for the specific proposal. If further help 
or information is needed, inquiries should be directed to HCFA at the 
address above.

(Catalog of Federal Domestic Assistance Program, No. 93.779; Health 
Financing Research, Demonstrations, and Experiments)

    Dated: November 30, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 95-30066 Filed 12-8-95; 8:45 am]
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