[Federal Register Volume 64, Number 55 (Tuesday, March 23, 1999)]
[Notices]
[Pages 13998-13999]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-7079]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-1100-N]
RIN 0938-AJ49
Medicare Program; Medicare Coordinated Care Demonstration Project
and Request for Information on Potential Best Practices of Coordinated
Care
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Solicitation of information.
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SUMMARY: This notice announces our intent to conduct the Medicare
Coordinated Care Demonstration. It informs interested parties of the
opportunity to submit information on examples of best practices of
coordinated care, as well as comment on potential aspects of the
overall Medicare Coordinated Care demonstration.
Section 4016 of the Balanced Budget Act of 1997 requires a review
of best practices and, following this assessment, a Medicare
Coordinated Care Demonstration to be launched by August 1999.
The purpose of the demonstration is to evaluate models of
coordinated care that improve the quality of services furnished to
specific beneficiaries and reduce expenditures under Parts A and B of
the Medicare program.
EFFECTIVE DATE: Information and comments will be considered if we
receive them at the address provided below, no later than 5 p.m., June
21, 1999.
ADDRESSES: Mail written comments (1 original and 3 copies) to the
following address: Mathematica Policy Research, Inc., Attn: Ms. Kristin
LaBounty, P.O. Box 2393, Princeton, NJ 08543-2393.
Comments may also be submitted electronically to Ms. LaBounty's e-
mail address (Klabounty@mathematica-mpr.com). Electronically submitted
comments should not include attachments.
Because of staffing and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code HCFA-1100-N.
FOR FURTHER INFORMATION CONTACT: Kathy Headen, Acting HCFA Project
Officer, (410) 786-9253 or Kristin LaBounty, (609) 275-2263.
SUPPLEMENTARY INFORMATION:
I. Background
Section 4016 of the Balanced Budget Act of 1997 (Public Law 105-33)
requires the Secretary of Health and Human Services (the Secretary) to
evaluate best practices in the private sector for methods of
coordinated care. The statute also directs the Secretary to design
demonstration projects for the Medicare fee-for-service population
based on the evaluation. The purpose of the demonstration is to
evaluate models of coordinated care that improve the quality of
services provided to specific beneficiaries who have a chronic illness
and reduce expenditures under Parts A and B of the Medicare program.
We competitively awarded a task order for conducting a review of
best practices in coordinated care and for providing a recommendation
of demonstration design options to Mathematica Policy Research, Inc.
(MPR). We will perform the final assessment of best practices and
select the demonstration design.
II. Provisions of This Notice
This notice announces our intent to conduct the Medicare
Coordinated Care Demonstration and informs interested parties of the
opportunity to submit information on potential best practices of
coordinated care. In addition, this notice also requests comments on
potential aspects of the overall demonstration. We are looking for
information on successful models of coordinated care, disease
management, or case management that are appropriate for the Medicare
fee-for-service population.
Information about, and evidence of, successful models can be found
in published literature; however, published literature is likely to be
a limited resource and successful programs may not have been
documented. Therefore, we would like to give interested parties the
opportunity to submit information about models of coordinated care that
are known to have achieved measurable success but may not have been
discussed in published literature.
We anticipate this information will complement the review being
conducted by MPR. Additional information regarding MPR's review can be
found on their website (www.mathematica-mpr.com/projects/
bestpractices).
Any person or organization may submit information about successful
programs; however, the information must provide evidence of success in
sufficient detail to be useful. Therefore, operators of programs may be
in the best position to submit information regarding their approach.
The following items of information should be submitted:
The name and address of the program.
The name, address, telephone number, facsimile number, and
e-mail address of a contact person.
Background on the program (including goals, history,
relationship to larger organization(s), number of clients served, and
length of time the program has been in operation).
Special or innovative features of the program.
Size and composition of the staff (number of RNs and
number of social workers performing case management).
[[Page 13999]]
Referral sources, targeting criteria, and selection
criteria, if any, for participants.
The patients served by the program (including age ranges,
diagnoses or conditions, and functional impairments).
Program intervention and how services differ from the
usual care the patient would have received.
How care plans are developed and monitored for each
patient.
Patient education efforts, if any.
Patient monitoring efforts, if any.
Feedback to providers, if any.
Average length of time patient is in the program.
Funding source(s) for the program.
Financial incentives, if any, for providers and patients
to participate.
Outcome measures by which the program's performance is
evaluated (including clinical, utilization, client-reported, and
financial measures used).
Program impacts on these measures.
Cost savings due to the program (total and per person
served per month).
How program impacts and cost savings were calculated (for
example, method of estimating reduction in use and costs, such as
comparison to control group or prior year experience).
Costs of operating the program (average per patient per
month costs).
Adaptability of the program to the Medicare fee-for-
service setting.
Program brochures or published articles, if any.
We are also interested in comments on potential aspects of the
overall demonstration. Specifically, we are interested in comments that
discuss and distinguish program characteristics known to be essential
for positive outcomes in a fee-for-service setting. Commenters may also
wish to address the types of providers, organizations, or entities
capable of, and qualified to provide, coordinated care or case
management services. Other aspects of importance include, but are not
limited to:
The relationship of the case management entity with other
providers.
The potential role of the case manager in authorizing or
providing services beyond coordinating and educational activities.
Appropriate incentives for the case management entity,
beneficiaries, and other providers.
Appropriate payment methodology.
Potential risk bearing arrangements for the case
management entity.
In addition, we seek comments regarding challenges to, and
potential solutions for, implementing a coordinated care demonstration
in rural sites.
We currently envision evaluating the data using a multi-tiered
review process that will focus on structure, process, and outcomes.
Review of individual programs will include the following review
criteria:
Programs that are currently functioning.
Programs that decrease health care costs or utilization
without adversely affecting health outcomes or that improve health
outcomes without increasing health care costs or utilization.
Programs that are suitable for the Medicare fee-for-
service population.
Programs that are targeted to common diseases in the
Medicare population.
We will also examine a program's structural characteristics and
specific features of its program interventions.
Responders should submit written information or comments to the
above address. We encourage the public to submit information or
comments as soon as possible to permit the maximum amount of time for
consideration. Written information or comments received by 5 p.m., June
21, 1999, will be considered in drafting the demonstration design
recommendations. Given the timeline for establishing this
demonstration, there will not be sufficient time to consider
information or comments received after this deadline.
III. Collection of Information Requirements
Section II of this notice contains information collection
requirements that were approved by the Office of Management and Budget
under the Paperwork Reduction Act of 1995 on January 5, 1999. The
approval number is 0938-0750 and the expiration date is June 30, 1999.
Authority: Section 4016 of the Balanced Budget Act of 1997
(Public Law 105-33).
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program;
and No. 93.774, Medicare--Supplementary Medical Insurance Program)
Dated: March 16, 1999.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 99-7079 Filed 3-22-99; 8:45 am]
BILLING CODE 4120-01-P
