Medicare Program; Solicitation for Applications for the Medical Adult Day-Care Services Demonstration, 36613-36615 [05-12524]
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Federal Register / Vol. 70, No. 121 / Friday, June 24, 2005 / Notices
other forms of information technology to
minimize the information collection
burden.
1. Type of Information Collection
Request: Revision of a currently
approved collection; Title of
Information Collection: Medicare
Provider Cost Report Reimbursement
Questionnaire and Supporting
Regulations in 42 CFR 413.20, 413.24,
and 415.60; Form Nos.: CMS–339 (OMB
# 0938–0301); Use: The purpose of Form
CMS–339 is to assist the provider in
preparing an acceptable cost report and
to minimize subsequent contact
between the provider and its
intermediary. Form CMS–339 provides
the basic data necessary to support the
information in the cost report. This
includes information the provider uses
to develop the provider and professional
components of physician compensation
so that compensation can be properly
allocated between the Part A and the
Part B trust funds. CMS is currently
working on eliminating Form CMS–339
and including the applicable questions
on the individual cost report forms.
Because of the time required to include
the applicable questions in each of the
individual cost reports, CMS is revising
the currently approved information
collection; Frequency: Annually;
Affected Public: Business or other forprofit, not-for-profit institutions, State,
local or tribal governments; Number of
Respondents: 35,904; Total Annual
Responses: 35,904; Total Annual Hours:
618,210.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’ Web site
address at https://www.cms.hhs.gov/
regulations/pra/, or e-mail your request,
including your address, phone number,
OMB number, and CMS document
identifier, to Paperwork@cms.hhs.gov,
or call the Reports Clearance Office on
(410) 786–1326.
Written comments and
recommendations for the proposed
information collections must be mailed
within 60 days of this notice to the
address below: CMS, Office of Strategic
Operations and Regulatory Affairs,
Division of Regulations Development,
Attention: William N. Parham, III, PRA
Analyst, Room C5–13–27, 7500 Security
Boulevard, Baltimore, Maryland 21244–
1850.
Dated: June 3, 2005.
Jim L. Wickliffe,
CMS Reports Clearance Officer, Regulations
Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 05–12161 Filed 6–23–05; 8:45 am]
BILLING CODE 4120–01–P
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19:06 Jun 23, 2005
Jkt 205001
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10130]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
In compliance with the requirement
of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Centers for Medicare & Medicaid
Services (CMS) is publishing the
following summary of proposed
collections for public comment.
Interested persons are invited to send
comments regarding this burden
estimate or any other aspect of this
collection of information, including any
of the following subjects: (1) The
necessity and utility of the proposed
information collection for the proper
performance of the agency’s functions;
(2) the accuracy of the estimated
burden; (3) ways to enhance the quality,
utility, and clarity of the information to
be collected; and (4) the use of
automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
1. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Federal Funding
of Emergency Health Services (Section
1011): Provider Payment Determination
and Request for Section 1011 On-Call
Payments; Form No.: CMS–10130 (OMB
# 0938–0952); Use: Section 1011 of
MMA provides that the Secretary will
establish a process for eligible providers
to request payment. The Secretary must
directly pay hospitals, physicians, and
ambulance providers (including Indian
Health Service, Indian tribe and tribal
organizations) for their otherwise unreimbursed costs of providing services
required by Section 1867 of the Social
Security Act (EMTALA) and related
hospital inpatient, outpatient and
ambulance services. Payments may be
made only for services furnished to
certain individuals described in the
statute as: (1) Undocumented aliens; (2)
aliens who have been paroled into the
United States at a United States port of
entry for the purpose of receiving
eligible services; and (3) Mexican
citizens permitted to enter the United
States for not more than 72 hours under
the authority of a biometric machine
readable border crossing identification
card (also referred to as a ‘‘laser visa’’)
AGENCY:
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36613
issued in accordance with the
requirements of regulations prescribed
under a specific section of the
Immigration and Nationality Act.;
Affected Public: Business or other forprofit, Not-for-profit institutions, and
State, Local or Tribal Governments;
Number of Respondents: 7,503,000;
Total Annual Responses: 7,512,000;
Total Annual Hours: 634,000.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’’ Web site
address at https://www.cms.hhs.gov/
regulations/pra/, or E-mail your request,
including your address, phone number,
OMB number, and CMS document
identifier, to Paperwork@cms.hhs.gov,
or call the Reports Clearance Office on
(410) 786–1326.
Written comments and
recommendations for the proposed
information collections must be mailed
within 60 days of this notice to the
address below: CMS, Office of Strategic
Operations and Regulatory Affairs,
Division of Regulations Development,
Attention: William N. Parham, III, PRA
Analyst, Room C5–13–27, 7500 Security
Boulevard, Baltimore, Maryland 21244–
1850.
Dated: June 17, 2005.
Michelle Shortt,
Acting Director, Regulations Development
Group, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 05–12492 Filed 6–23–05; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–5022–N]
Medicare Program; Solicitation for
Applications for the Medical Adult DayCare Services Demonstration
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice for solicitation of
applications.
AGENCY:
SUMMARY: This notice informs interested
parties of an opportunity to apply for
participation in the Medical Adult DayCare Services Demonstration. This
demonstration tests an alternative
approach to service delivery by allowing
home health beneficiaries to receive a
portion of the medical services included
in their home health plan of care in a
medical adult day-care facility
(MADCF). The project will allow us to
test potential improvements in quality
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36614
Federal Register / Vol. 70, No. 121 / Friday, June 24, 2005 / Notices
of care, outcomes, and program
efficiency related to the provision of
home health services in an MADCF
setting. We intend to use a competitive
application process to select up to five
sites to participate in this
demonstration. This demonstration is
restricted to the States that license or
certify medical adult day-care facilities.
FOR FURTHER INFORMATION AND TO OBTAIN
A COPY OF THE SOLICITATION: Interested
parties can obtain complete solicitation
submission requirements and
supporting information about this
demonstration at the Medical Adult
Day-Care Services Demonstration
webpage found at the following Web
site address: https://www.cms.hhs.gov/
researchers/demos/MADCS/default.asp.
Or by contacting: Armen Thoumaian,
Ph.D., Mail Stop: S3–02–01, Centers for
Medicare & Medicaid Services, 7500
Security Boulevard, Baltimore,
Maryland 21244. Phone: (410) 786–6672
or toll free at (877) 267–2323, Ext.
66672. E-mail address:
AThoumaian@cms.hhs.gov.
Effective Date: Applications
must be received by September 22,
2005.
DATES:
Mail applications to—
Centers for Medicare & Medicaid
Services, Attention: Dr. Armen
Thoumaian, Mail Stop: S3–02–01, 7500
Security Boulevard, Baltimore,
Maryland 21244. Because of staff and
resource limitations, we cannot accept
applications by facsimile (FAX)
transmission or by e-mail. Applicants
will receive a communication
acknowledging the receipt of their
application.
ADDRESSES:
SUPPLEMENTARY INFORMATION:
I. Background
Section 703 of the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA)(Pub.
L. 108–173, enacted on December 8,
2003) requires that the Secretary shall
establish a demonstration project under
which the Secretary shall, as part of a
plan of care for home health services
established for a Medicare beneficiary
by a physician, permit a home health
agency (HHA), directly or under
arrangements with a medical adult daycare facility (MADCF), to provide
medical adult day-care services as a
substitute for a portion of home health
services that would otherwise be
provided in the beneficiary’s home.
Participation in the demonstration by
Medicare beneficiaries admitted for
home health care is voluntary. The
demonstration is limited to not more
than five sites and associated
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Jkt 205001
MADCF(s). Each site may include all
States in which it provides home health
services as long as the adult day-care
services are provided in MADCFs
licensed or certified in one of the States
that license or certify medical adult day
care facilities. Treatment under the 3year demonstration is limited across all
sites to 15,000 beneficiaries at any one
time. For those Medicare beneficiaries
who agree to participate in the
demonstration, the HHA will receive 95
percent of the prospective payment
system (PPS) amount that otherwise
would have been paid for the home
health episode of care had all services
been delivered in the beneficiary’s
home.
The purpose of this demonstration is
to evaluate the outcomes and costs of
providing innovative models of health
care that include both home health care
services and medical adult day-care
services that improve the quality of life
for Medicare beneficiaries. An
independent evaluation will be
conducted for this demonstration. At
the conclusion of the demonstration, the
Secretary must report to the Congress an
evaluation of the clinical and costeffectiveness of the demonstration as
well as recommendations for the
extension or termination of the project.
II. Purpose
This notice solicits applications for a
demonstration project in which
Medicare-certified HHAs, in partnership
with a medical adult day-care facility
(MADCF), or facilities, provide medical
adult day-care services as a substitute
for a portion of home health care
services that would otherwise be
provided in the beneficiary’s home. The
demonstration is initiated to determine
whether these provisions will result in
higher quality care with better
utilization of Medicare-covered services
while promoting the physical and
mental health of participating Medicare
beneficiaries. The Medical Adult DayCare Services Demonstration will allow
a home health agency (directly or in
conjunction with adult day health
facilities) to provide a portion of the
services included in the home health
plan of care in a MADCF setting rather
than in the beneficiary’s home. As such,
the demonstration will allow us to
gather data on the efficacy and costeffectiveness of providing those services
in the adult day health setting as an
alternative to the home. Additional
important outcomes from this
demonstration project include:
measuring impacts on the amounts and
types of home health and other
Medicare services beneficiaries receive
and settings in which they receive them;
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utilization of other (non-Medicare
covered) adult day health center
services; beneficiary health, function,
and satisfaction; family/caregiver
satisfaction; beneficiary out of pocket
cost and total program costs; and HHA
and MADCF financial outcomes. Most
importantly, we can learn whether
beneficiaries are willing to receive part
of their home health services at an
MADCF.
III. Site Selection
Section 703 of the MMA provides that
the Secretary shall conduct a three-year
demonstration project in not more than
five sites in States that license or certify
providers of services that furnish
medical adult day-care services.
Potential sites are restricted to these
states. The following 36 states have been
identified as meeting this requirement:
AK, AZ, CA, CO, DE, FL, HI, IA, KS, KY,
LA, MA, ME, MD, MN, MO, MT, NE,
NH, NJ, NV, NM, NC, NY, OK, PA, RI,
SC, TN, TX, UT, VA, VT, WI, WV, WY.
Applicants from states not listed must
provide evidence that the state licenses
or certifies providers of services that
furnish medical adult day-care services.
A demonstration site is defined as a
single HHA or a corporate entity that
includes one or more HHAs providing
services in one or more of the eligible
States. Pursuant to section 703(f) of the
MMA, preference will be given to those
agencies that are currently licensed or
certified through common ownership
and control to furnish medical adult
day-care services according. We will
require that all sites selected to
participate in the demonstration be
associated through ownership or
through contractual agreement with one
or more MADCFs. Sites will be selected
based on the proposals that clearly and
most convincingly address the issues set
forth in the solicitation on our Web site:
https://www.cms.hhs.gov/researchers/
demos/MADCS/default.asp.
Under the demonstration, the HHAs
will be permitted to deliver (or contract
for the delivery of) medical adult daycare services as a substitute for a portion
of a beneficiary’s home health care
services at an affiliated MADCF that has
been State licensed or certified for at
least 2 years.
IV. Beneficiary Eligibility and
Enrollment
The demonstration will be open to all
Medicare beneficiaries that meet the
Medicare eligibility requirements for
receiving home health care services
through the Medicare fee-for-service
program. Participation by Medicare
beneficiaries in the demonstration is
voluntary. Participating HHAs will
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Federal Register / Vol. 70, No. 121 / Friday, June 24, 2005 / Notices
conduct patient assessments and other
required activities as they normally
would under the Medicare conditions of
participation except that they would be
able to offer Medicare home health
patients the opportunity to receive a
portion of their care in a MADCF.
During the initial and follow-up patient
assessments, HHAs will have the
opportunity to identify beneficiaries
who might benefit from adult day-care
services. Demonstration participants are
those beneficiaries who agree to
participate in the demonstration and
receive part of their home health
services at the MADCF. Those who
agree should also be informed that they
will be contacted in the future by the
demonstration support and evaluation
contractor(s).
Participation by Medicare
beneficiaries is completely voluntary
and participating beneficiaries have the
option of withdrawing from
participation at any time. Up to 15,000
beneficiaries across the five sites may
participate in the demonstration at any
given time. Sites will be provided with
enrollment limits proportional to their
capacity prorated against the combined
total of 15,000 enrollees at any one time.
This will be done to ensure that smaller
sites will have an opportunity to enroll
a fair portion of the total enrollment
allowed under the demonstration.
V. Payment
The information collection
requirements associated with this notice
are subject to the Paperwork Reduction
Act of 1995 (PRA); however, the
collection is currently approved under
OMB control number 0938–0880
entitled ‘‘Medicare Demonstration
Waiver Application’’ with a current
expiration date of July 31, 2006.
Authority: Section 703 of the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA), Pub. L.
108–173.
Dated: April 29, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare &
Medicaid Services.
[FR Doc. 05–12524 Filed 6–23–05; 8:45 am]
BILLING CODE 4121–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–2219–N]
RIN 0938–ZA17
State Children’s Health Insurance
Program; Final Allotments to States,
the District of Columbia, and U.S.
Territories and Commonwealths for
Fiscal Year 2006
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
Under the demonstration, the
participating HHAs will be paid 95
percent of the prospective payment
system (PPS) amount that otherwise
would have been paid for the home
health episode of care had all services
been delivered in the beneficiary’s
home. Current provisions related to
case-mix group assignment and
payment adjustments are not affected by
the demonstration. Payment will be
provided directly to the HHA for all
services delivered during the home
health episode of care whether provided
at home or in the adult day health
facility. Under section 703(b)(1) of the
MMA, the beneficiary may not be
separately charged for medical adultday care services furnished as part of
the home health plan of care.
The statute requires the Secretary to
monitor the demonstration to ensure
that the provision of services in the
demonstration does not result in a net
increase in total spending, and provides
the authority to make payment
adjustments to ensure that budget
neutrality is maintained.
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VI. Collection of Information
Requirements
19:06 Jun 23, 2005
Jkt 205001
SUMMARY: Title XXI of the Social
Security Act (the Act) authorizes
payment of Federal matching funds to
States, the District of Columbia, and
U.S. Territories and Commonwealths to
initiate and expand health insurance
coverage to uninsured, low-income
children under the State Children’s
Health Insurance Program (SCHIP). This
notice sets forth the final allotments of
Federal funding available to each State,
the District of Columbia, and each U.S.
Territory and Commonwealth for fiscal
year 2006.
DATES: Effective Date: This notice is
effective on July 25, 2005. Final
allotments are available for
expenditures after October 1, 2005.
FOR FURTHER INFORMATION CONTACT:
Richard Strauss, (410) 786–2019.
SUPPLEMENTARY INFORMATION:
I. Purpose of This Notice
This notice sets forth the allotments
available to each State, the District of
Columbia, and each U.S. Territory and
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36615
Commonwealth for fiscal year (FY) 2006
under title XXI of the Social Security
Act (the Act). Final allotments for a
fiscal year are available to match
expenditures under an approved State
child health plan for 3 fiscal years,
including the year for which the final
allotment was provided. The FY 2006
allotments will be available to States for
FY 2006, and unexpended amounts may
be carried over to FY 2007 and FY 2008.
Federal funds appropriated for title XXI
are limited, and the law specifies a
formula to divide the total annual
appropriation into individual allotments
available for each State, the District of
Columbia, and each U.S. Territory and
Commonwealth with an approved child
health plan.
Section 2104(b)(1) and (c)(3) of the
Act requires States, the District of
Columbia, and U.S. Territories and
Commonwealths to have an approved
child health plan for the fiscal year in
order for the Secretary to provide an
allotment for that fiscal year. All States,
the District of Columbia, and U.S.
Territories and Commonwealths have
approved plans for FY 2006. Therefore,
the FY 2006 allotments contained in
this notice pertain to all States, the
District of Columbia, and U.S.
Territories and Commonwealths.
II. Methodology for Determining Final
Allotments for States, the District of
Columbia, and U.S. Territories and
Commonwealths
Section 2104(a) of the Act provides
that, for purposes of providing
allotments to the States, the District of
Columbia, and U.S. Territories and
Commonwealths, the following amounts
are appropriated: $4,295,000,000 for FY
1998; $4,275,000,000 for each FY 1999
through FY 2001; $3,150,000,000 for
each FY 2002 through FY 2004;
$4,050,000,000 for each FY 2005
through FY 2006; and $5,000,000,000
for FY 2007.
This notice specifies, in the Table
under section III, the final FY 2006
allotments available to individual
States, the District of Columbia, and
U.S. Territories and Commonwealths for
either child health assistance
expenditures under approved State
child health plans or for claiming an
enhanced Federal medical assistance
percentage rate for certain SCHIPrelated Medicaid expenditures. As
discussed below, the FY 2006 final
allotments have been calculated to
reflect the methodology for determining
an allotment amount for each State, the
District of Columbia, and each U.S.
Territory and Commonwealth as
prescribed by section 2104(b) and (c) of
the Act.
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]]>Agencies
[Federal Register Volume 70, Number 121 (Friday, June 24, 2005)]
[Notices]
[Pages 36613-36615]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-12524]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5022-N]
Medicare Program; Solicitation for Applications for the Medical
Adult Day-Care Services Demonstration
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice for solicitation of applications.
-----------------------------------------------------------------------
SUMMARY: This notice informs interested parties of an opportunity to
apply for participation in the Medical Adult Day-Care Services
Demonstration. This demonstration tests an alternative approach to
service delivery by allowing home health beneficiaries to receive a
portion of the medical services included in their home health plan of
care in a medical adult day-care facility (MADCF). The project will
allow us to test potential improvements in quality
[[Page 36614]]
of care, outcomes, and program efficiency related to the provision of
home health services in an MADCF setting. We intend to use a
competitive application process to select up to five sites to
participate in this demonstration. This demonstration is restricted to
the States that license or certify medical adult day-care facilities.
FOR FURTHER INFORMATION AND TO OBTAIN A COPY OF THE SOLICITATION:
Interested parties can obtain complete solicitation submission
requirements and supporting information about this demonstration at the
Medical Adult Day-Care Services Demonstration webpage found at the
following Web site address: https://www.cms.hhs.gov/researchers/demos/
MADCS/default.asp.
Or by contacting: Armen Thoumaian, Ph.D., Mail Stop: S3-02-01,
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244. Phone: (410) 786-6672 or toll free at (877)
267-2323, Ext. 66672. E-mail address: AThoumaian@cms.hhs.gov.
DATES: Effective Date: Applications must be received by September 22,
2005.
ADDRESSES: Mail applications to--Centers for Medicare & Medicaid
Services, Attention: Dr. Armen Thoumaian, Mail Stop: S3-02-01, 7500
Security Boulevard, Baltimore, Maryland 21244. Because of staff and
resource limitations, we cannot accept applications by facsimile (FAX)
transmission or by e-mail. Applicants will receive a communication
acknowledging the receipt of their application.
SUPPLEMENTARY INFORMATION:
I. Background
Section 703 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA)(Pub. L. 108-173, enacted on December 8,
2003) requires that the Secretary shall establish a demonstration
project under which the Secretary shall, as part of a plan of care for
home health services established for a Medicare beneficiary by a
physician, permit a home health agency (HHA), directly or under
arrangements with a medical adult day-care facility (MADCF), to provide
medical adult day-care services as a substitute for a portion of home
health services that would otherwise be provided in the beneficiary's
home. Participation in the demonstration by Medicare beneficiaries
admitted for home health care is voluntary. The demonstration is
limited to not more than five sites and associated MADCF(s). Each site
may include all States in which it provides home health services as
long as the adult day-care services are provided in MADCFs licensed or
certified in one of the States that license or certify medical adult
day care facilities. Treatment under the 3-year demonstration is
limited across all sites to 15,000 beneficiaries at any one time. For
those Medicare beneficiaries who agree to participate in the
demonstration, the HHA will receive 95 percent of the prospective
payment system (PPS) amount that otherwise would have been paid for the
home health episode of care had all services been delivered in the
beneficiary's home.
The purpose of this demonstration is to evaluate the outcomes and
costs of providing innovative models of health care that include both
home health care services and medical adult day-care services that
improve the quality of life for Medicare beneficiaries. An independent
evaluation will be conducted for this demonstration. At the conclusion
of the demonstration, the Secretary must report to the Congress an
evaluation of the clinical and cost-effectiveness of the demonstration
as well as recommendations for the extension or termination of the
project.
II. Purpose
This notice solicits applications for a demonstration project in
which Medicare-certified HHAs, in partnership with a medical adult day-
care facility (MADCF), or facilities, provide medical adult day-care
services as a substitute for a portion of home health care services
that would otherwise be provided in the beneficiary's home. The
demonstration is initiated to determine whether these provisions will
result in higher quality care with better utilization of Medicare-
covered services while promoting the physical and mental health of
participating Medicare beneficiaries. The Medical Adult Day-Care
Services Demonstration will allow a home health agency (directly or in
conjunction with adult day health facilities) to provide a portion of
the services included in the home health plan of care in a MADCF
setting rather than in the beneficiary's home. As such, the
demonstration will allow us to gather data on the efficacy and cost-
effectiveness of providing those services in the adult day health
setting as an alternative to the home. Additional important outcomes
from this demonstration project include: measuring impacts on the
amounts and types of home health and other Medicare services
beneficiaries receive and settings in which they receive them;
utilization of other (non-Medicare covered) adult day health center
services; beneficiary health, function, and satisfaction; family/
caregiver satisfaction; beneficiary out of pocket cost and total
program costs; and HHA and MADCF financial outcomes. Most importantly,
we can learn whether beneficiaries are willing to receive part of their
home health services at an MADCF.
III. Site Selection
Section 703 of the MMA provides that the Secretary shall conduct a
three-year demonstration project in not more than five sites in States
that license or certify providers of services that furnish medical
adult day-care services. Potential sites are restricted to these
states. The following 36 states have been identified as meeting this
requirement: AK, AZ, CA, CO, DE, FL, HI, IA, KS, KY, LA, MA, ME, MD,
MN, MO, MT, NE, NH, NJ, NV, NM, NC, NY, OK, PA, RI, SC, TN, TX, UT, VA,
VT, WI, WV, WY. Applicants from states not listed must provide evidence
that the state licenses or certifies providers of services that furnish
medical adult day-care services.
A demonstration site is defined as a single HHA or a corporate
entity that includes one or more HHAs providing services in one or more
of the eligible States. Pursuant to section 703(f) of the MMA,
preference will be given to those agencies that are currently licensed
or certified through common ownership and control to furnish medical
adult day-care services according. We will require that all sites
selected to participate in the demonstration be associated through
ownership or through contractual agreement with one or more MADCFs.
Sites will be selected based on the proposals that clearly and most
convincingly address the issues set forth in the solicitation on our
Web site: https://www.cms.hhs.gov/researchers/demos/MADCS/default.asp.
Under the demonstration, the HHAs will be permitted to deliver (or
contract for the delivery of) medical adult day-care services as a
substitute for a portion of a beneficiary's home health care services
at an affiliated MADCF that has been State licensed or certified for at
least 2 years.
IV. Beneficiary Eligibility and Enrollment
The demonstration will be open to all Medicare beneficiaries that
meet the Medicare eligibility requirements for receiving home health
care services through the Medicare fee-for-service program.
Participation by Medicare beneficiaries in the demonstration is
voluntary. Participating HHAs will
[[Page 36615]]
conduct patient assessments and other required activities as they
normally would under the Medicare conditions of participation except
that they would be able to offer Medicare home health patients the
opportunity to receive a portion of their care in a MADCF. During the
initial and follow-up patient assessments, HHAs will have the
opportunity to identify beneficiaries who might benefit from adult day-
care services. Demonstration participants are those beneficiaries who
agree to participate in the demonstration and receive part of their
home health services at the MADCF. Those who agree should also be
informed that they will be contacted in the future by the demonstration
support and evaluation contractor(s).
Participation by Medicare beneficiaries is completely voluntary and
participating beneficiaries have the option of withdrawing from
participation at any time. Up to 15,000 beneficiaries across the five
sites may participate in the demonstration at any given time. Sites
will be provided with enrollment limits proportional to their capacity
prorated against the combined total of 15,000 enrollees at any one
time. This will be done to ensure that smaller sites will have an
opportunity to enroll a fair portion of the total enrollment allowed
under the demonstration.
V. Payment
Under the demonstration, the participating HHAs will be paid 95
percent of the prospective payment system (PPS) amount that otherwise
would have been paid for the home health episode of care had all
services been delivered in the beneficiary's home. Current provisions
related to case-mix group assignment and payment adjustments are not
affected by the demonstration. Payment will be provided directly to the
HHA for all services delivered during the home health episode of care
whether provided at home or in the adult day health facility. Under
section 703(b)(1) of the MMA, the beneficiary may not be separately
charged for medical adult-day care services furnished as part of the
home health plan of care.
The statute requires the Secretary to monitor the demonstration to
ensure that the provision of services in the demonstration does not
result in a net increase in total spending, and provides the authority
to make payment adjustments to ensure that budget neutrality is
maintained.
VI. Collection of Information Requirements
The information collection requirements associated with this notice
are subject to the Paperwork Reduction Act of 1995 (PRA); however, the
collection is currently approved under OMB control number 0938-0880
entitled ``Medicare Demonstration Waiver Application'' with a current
expiration date of July 31, 2006.
Authority: Section 703 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-173.
Dated: April 29, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-12524 Filed 6-23-05; 8:45 am]
BILLING CODE 4121-01-P
