Medicare Program; Senior Risk Reduction Demonstration, 49460-49461 [06-7120]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 71, Number 163 (Wednesday, August 23, 2006)]
[Notices]
[Pages 49460-49461]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-7120]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5035-N]


Medicare Program; Senior Risk Reduction Demonstration

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

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice informs interested parties of an opportunity to 
apply to participate in a risk reduction/health management 
demonstration project. This notice also contains information on how to 
obtain the complete solicitation and supporting information.

DATES: Applications will be considered timely if we receive them on or 
before November 21, 2006.

[[Page 49461]]


ADDRESSES: Mail applications for the Senior Risk Reduction 
Demonstration to--Centers for Medicare & Medicaid Services, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.
    Medicare Demonstrations Program Group, Mail stop S3-02-01, 
Attention: Pauline Lapin.

FOR FURTHER INFORMATION CONTACT: Pauline Lapin, (410) 786-6883 or 
Sidney Trieger, (410) 786-6613.

SUPPLEMENTARY INFORMATION: 

I. Background

    The aging of the population, the prevalence of chronic disease, and 
the rapidly rising cost of health care in the United States provides a 
sense of urgency and immediacy for finding innovative solutions that 
would improve the health and well-being of seniors and prevent or delay 
debilitating and costly disease onset.
    Recent research suggests that well-structured risk reduction 
programs can achieve significant improvements in a population's health 
risk profile. Successful programs are founded on solid behavior change 
theory, use tailored interventions, are personalized and sufficiently 
intensive, and are delivered with adequate social supports. In 2001, 
CMS commissioned RAND, and RAND prepared, a report on risk reduction 
programs entitled, ``The Evidence Report and Evidence Based 
Recommendations: Health Risk Appraisals and Medicare.'' This report 
concluded that effective risk reduction programs, beginning with the 
administration of a Health Risk Appraisal (HRA) and including evidence-
based and tailored behavior change through follow-up interventions, 
exert a beneficial effect on behavioral, physiological, and general 
health status outcomes. Other supportive studies have shown that 
multicomponent health promotion programs that engage participants in 
self-care activities and increase their involvement in health care 
decision-making can achieve long-term behavior changes and health risk 
reductions in large populations.
    Also, evidence is mounting that successful risk reduction programs 
may produce a positive return on investment. Based on this evidence, 
the RAND report concluded that health promotion and disease prevention 
programs using HRAs and ongoing tailored interventions may be cost 
beneficial. Experts agree that the approach used in risk reduction 
programs is promising for Medicare beneficiaries and should be tested 
in a demonstration project.

II. Provisions of the Notice

    The purpose of the notice is to inform interested parties of an 
opportunity to implement a risk reduction/health management program as 
part of the Medicare Senior Risk Reduction Demonstration. The goal of 
this demonstration project is to determine whether risk reduction 
programs (also referred to as health promotion, health management, 
demand management, and disease prevention programs) that have been 
developed and tested in the private sector can also be tailored to, and 
work well with, Medicare beneficiaries to improve their health and 
reduce avoidable health care utilization. The specific aims are to--
     Determine whether a senior risk reduction service provided 
by Medicare will--

--Be viewed positively by beneficiaries.
--Be accepted by beneficiaries.
--Achieve high participation rates.
--Reduce health risk factors, improve health behaviors, improve 
functioning, and prevent disability.

     Produce cost savings for the Medicare program.
    Applicants must be willing to accept a 10 percent withhold of their 
fee each year, and as much as a 15 percent withhold over the course of 
the demonstration should Medicare expenditures for the intervention 
group exceed those of the control group by more than 5 percent after 
the first 18 months of the demonstration.
    We intend to use a competitive application process to select up to 
five existing health promotion, disease prevention, health management, 
or risk reduction organizations to participate in the demonstration 
project. Interested parties can obtain complete solicitation and 
supporting information on the CMS Web site at https://www.cms.hhs.gov/
DemoProjectsEvalRpts/downloads/Senior_Risk_Reduction_
Solicitation.pdf.
    We anticipate that we will make final award decisions by April 1, 
2007, and that project implementation activities would begin July 1, 
2007.

III. Collection of Information Requirements

    The document does impose information collection and recordkeeping 
requirements. However, since we believe there are less than 10 
potential respondents, of which CMS will be selecting 5 applicants to 
participate in the demonstration, this collection is exempt from the 
PRA as stipulated under 5 CFR 1320.3(c)(4).

    Authority: Section 402(a)(1)(B) of the Social Security 
Amendments of 1967, Pub. L. No. 90-248, as amended, 42 U.S.C. 1395b-
1(a)(1)(B) and (a)(2).

(Catalog of Federal Domestic Assistance No. 93.773 Medicare--
Hospital Insurance Program; and No. 93.774, Medicare--Supplementary 
Medical Insurance Program).

    Dated: July 20, 2006.
Mark B. McClellan,
Administrator, Centers for Medicaid & Medicare Services.
[FR Doc. 06-7120 Filed 8-21-06; 4:00 pm]
BILLING CODE 4120-01-M