[Federal Register Volume 61, Number 177 (Wednesday, September 11, 1996)]
[Notices]
[Pages 47946-47950]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-23115]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[ORD-091-N]
New and Pending Demonstration Project Proposals Submitted
Pursuant to Section 1115(a) of the Social Security Act
July 1996.
AGENCY: Health Care Financing Administration (HCFA).
ACTION: Notice.
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SUMMARY: This notice identifies proposals submitted during the month of
July 1996 under the authority of section 1115 of the Social Security
Act and those that were approved, disapproved, pending, or withdrawn
during this time period. (This notice can be accessed on the Internet
at HTTP://WWW.HCFA.GOV/ORD/ORDHP1.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 (410) 786-3996.
[[Page 47947]]
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
Month of July 1996
A. Comprehensive Health Reform Programs
1. New Proposals
No new proposals were received during the month of July.
2. Pending Proposals
We have included a complete listing of 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, P.O. 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: The Georgia Behavioral Health Plan--
Georgia.
Description: Georgia proposes to provide behavioral health services
under a managed care system through a 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 are not otherwise eligible for
Medicaid.
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, (404) 657-2012.
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: 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, (913) 296-4719.
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: 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, (504) 342-2964.
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: Maryland Medicaid Reform Proposal--
Maryland.
Description: A statewide section 1115 demonstration proposal has
been developed to: provide a patient-focused system through managed
care entities; build on the strengths of the current Maryland health
care system; provide comprehensive, prevention-orientated systems of
care; hold Managed Care Organizations (MCOs) accountable for high-
quality care; and achieve better value and predictability for State
expenditures.
Date Received: May 3, 1996.
[[Page 47948]]
State Contact: Mary Mussman, M.D., M.P.H., Acting Executive
Director, Center for Health Program Development and Management, Social
Sciences Building, Room 309A, 5401 Wilkens Avenue, Baltimore, MD 21228-
5398, (410) 455-6804.
Federal Project Officer: Gina Clemons, Health Care Financing
Administration, Office of Research and Demonstrations, Office of State
Health Reform Demonstrations, Mail Stop C3-18-36, 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 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, (314) 751-6922.
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: Community Care Systems--New Hampshire.
Description: The State submitted a revised proposal for ``Community
Care Systems.'' This system will provide capitated, managed acute care
services not included in the health plan service package. The State
proposed to implement this program in three phases: Phase 1 will enroll
AFDC and AFDC-related children and families; Phase 2 will enroll the
elderly population; and Phase 3 will enroll disabled adults and
disabled children. The current waiver request is for Phase 1 only.
Date Received: June 5, 1996.
State Contact: Lorrie Lutz, Planning and Policy Development, State
of New Hampshire, Department of Health and Human Services, 6 Hazen
Drive, Concord, NY 03301-6505, (603) 271-4478.
Federal Project Officer: Cindy Shirk, Health Care Financing
Administration, Office of Research and Demonstrations, Office of State
Health Reform 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.
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,
(518) 474-9132.
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: 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 Contact: Cathy Rossberg, State Medicaid Office, P.O. Box
13247, Austin, TX 78711, (512) 502-3224.
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.
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, (801) 538-6406.
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 Proposals
No conceptual proposals were approved nor grant proposals awarded
during the month of July. The following comprehensive health reform
proposal was approved during the month of July:
Demonstration Title/State: MediPlan Plus--Illinois.
Description: Illinois' section 1115 demonstration program,
``MediPlan Plus'' seeks to increase access and quality of health care
for 1.1 million of the State's Medicaid beneficiaries and limit rising
costs through the increased use of managed care. Illinois intends to
contract with a mix of health maintenance organizations (HMOs), managed
care community networks (MCCNs), and enrolled managed care providers
that incorporate Federally Qualified Health Centers, Rural Health
Clinics, and physicians who agree to provide primary care case
management services. In addition, as a transition to managed care, for
a limited period, community providers who are interested in forming a
MCCN will be permitted to participate as a Prepaid Health Plan in order
to gain incremental experience in operating a managed care delivery
system. MediPlan Plus will be implemented statewide. In areas where
MCCN capacity exists, the State will be given a waiver of HMO freedom-
of-choice and exemptions from the lock-in provisions and the 75/25
composition provision. In areas where there is not sufficient MCCN
access, only the waivers permissible through the 1915(b) program
(freedom-of-choice) will be granted.
Date Received: September 14, 1994.
Date Approved: July 12, 1996.
State Contact: George Hovanec, Medicaid Director, Medical
Operations, Department of Public Aid, 201 South Grand Avenue, East,
Third Floor, Springfield, IL 62763-0001, (217) 782-2570.
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.
4. Disapproved Proposals
No comprehensive health reform proposals were disapproved during
the month of July.
[[Page 47949]]
5. Withdrawn Proposals
No comprehensive health reform proposals were withdrawn during the
month of July.
B. Other Section 1115 Demonstration Proposals
1. New Proposals
The following new proposals were received during the month of July:
Demonstration Title/State: Continuing Care Networks (CCN)
Demonstration--Monroe County, New York.
Description: The CCN project is designed to test the efficiency and
effectiveness of financing and delivery systems which integrate
primary, acute and long term care services under combined Medicare and
Medicaid capitation payments. Participants will be both Medicare only,
and dually eligible Medicare/Medicaid beneficiaries, who are 65 or
older. Enrollment will be voluntary for all participants.
Date Received: July 1, 1996.
State Contact: C. Christopher Rush, Assistant Bureau, Director,
Bureau of Long Term Care, Division of Health and Long Term Care, New
York State Department of Social Services, 40 North Pearl Street,
Albany, New York 12243-0001, (518) 473-5507.
Federal Project Officer: Kay Lewandowski, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-23-
04, 7500 Security Boulevard, Baltimore, MD 21244-1850.
2. Pending Proposals
We have included a complete listing of 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 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: 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, (303) 866-5912.
Federal Project Officer: Melissa McNiff, Health Care Financing
Administration, Office of Research and Demonstrations, Mail Stop C3-18-
26, 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: 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, (517) 335-5117.
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, (406) 444-4540.
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, (505) 827-3106.
[[Page 47950]]
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. (401) 464-3234.
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, (803) 253-6100.
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.
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, (608) 266-0613.
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.
Demonstration Title/State: Wisconsin Partnership Program--
Wisconsin.
Description: Wisconsin has submitted Medicare section 222
demonstration and Medicaid section 1115 waiver requests to implement
the ``Wisconsin Partnership Program'' in specific counties of the
State. This program will test two innovative models of care, one for
frail elderly and one for persons with disabilities, utilizing a multi-
disciplinary team to manage care. The team is to include the
beneficiary, a nurse practitioner, the beneficiary's choice of primary
care physician, and a social worker or independent living coordinator.
Consumer choice of care, settings and the manner of service delivery is
a key component of the program. The demonstration will test the use of
consumer-defined quality indicators to measure and improve the quality
of service provided to people who are elderly and people with
disabilities.
Date Received: February 28, 1996.
State Contact: Mary Rowin, State of Wisconsin, Department of Health
and Social Services, 1 West Wilson Street, P.O. Box 7850, Madison, WI
53707, (608) 261-8885.
Federal Contact: William Clark, Health Care Financing
Administration, Office of Research and Demonstrations, Office of
Beneficiary and Program Research and Demonstrations, Mail Stop C3-21-
06, 7500 Security Boulevard, Baltimore, MD 21244-1850.
3. Approved Proposals
No conceptual or other proposals were approved during the month of
July.
4. Disapproved Proposals
No proposals were disapproved during the month of July.
5. Withdrawn Proposals
No proposals were withdrawn during the month of July.
III. 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: August 15, 1996.
Barbara Cooper,
Acting Director, Office of Research and Demonstrations.
[FR Doc. 96-23115 Filed 9-10-96; 8:45 am]
BILLING CODE 4120-01-P
