Medicare Program; Advanced Payment Model, 68012 [2011-27458]

Agencies

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

[Federal Register Volume 76, Number 212 (Wednesday, November 2, 2011)]
[Notices]
[Page 68012]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-27458]



[[Page 68011]]

Vol. 76

Wednesday,

No. 212

November 2, 2011

Part IV





Department of Health and Human Services





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Centers for Medicare & Medicaid Services





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 Medicare Program; Advanced Payment Model; Notice

Federal Register / Vol. 76, No. 212 / Wednesday, November 2, 2011 / 
Notices

[[Page 68012]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5505-N]


Medicare Program; Advanced Payment Model

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

ACTION: Notice.

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SUMMARY: This notice announces the testing of the Advance Payment Model 
for certain accountable care organizations participating in the 
Medicare Shared Savings Program scheduled to begin in 2012, and 
provides information about the model and application process.

DATES: Application Submission Deadline: Applicants must submit both the 
application for the Medicare Shared Savings Program and the application 
for the Advance Payment Model by the Shared Savings Program 
deadline(s). Additional information is available on the Innovation 
Center Web site at https://www.innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.

FOR FURTHER INFORMATION CONTACT: Questions regarding the Advance 
Payment Model or the application process should be sent to 
advpayaco@cms.hhs.gov.

SUPPLEMENTARY INFORMATION: 

I. Background

    The Centers for Medicare & Medicaid Services (CMS) is committed to 
achieving the three-part aim of better health, better health care, and 
reduced expenditures through continuous improvement for Medicare, 
Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries. 
One potential mechanism for achieving this goal is for CMS to partner 
with groups of health care providers of services and suppliers with a 
mechanism for shared governance that have formed an Accountable Care 
Organization (ACO) through which they work together to coordinate care 
for a specified group of patients. We will pursue such partnerships 
through complementary efforts, including the Medicare Shared Savings 
Program and initiatives undertaken by the Center for Medicare and 
Medicaid Innovation (Innovation Center).
    The Advance Payment Model is an Innovation Center initiative 
designed for participants in the Medicare Shared Savings Program in 
need of prepayment of expected shared savings to build their capacity 
to provide high quality, coordinated care and generate cost savings. 
The Advance Payment Model will test whether and how pre-paying a 
portion of future shared savings could increase participation in the 
Medicare Shared Savings Program, and whether advance payments will 
increase the amount of and speed at which ACOs can effectively 
coordinate care to generate Medicare savings. More information about 
the initiative, including instructions on how to apply, is available on 
the Innovation Center Web site at https://www.innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment.

II. Provisions of the Notice

    Consistent with its authority under section 1115A of the Social 
Security Act (the Act) to test innovative payment and service delivery 
models that reduce spending under Medicare, Medicaid, or CHIP, while 
preserving or enhancing the quality of care, the Innovation Center aims 
to achieve the following goals through implementation of the Advance 
Payment Model:
     Test whether advance payments will increase the amount of 
and speed at which ACOs in the Medicare Shared Savings Program can 
generate Medicare savings.
     Test whether and how pre-paying a portion of future shared 
saving could increase participation in the Medicare Shared Savings 
Program.
    The Advance Payment model is intended for organizations in need of 
additional access to capital to make investments necessary for 
coordinating care, including rural and physician-led ACOs. Not every 
participant in the Shared Savings Program will be eligible to receive 
an advance payment. Additional information about eligibility 
requirements is available in the solicitation available on the 
Innovation Center Web site--https://www.innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.
    Selected ACOs will receive three types of payments: (1) An upfront, 
fixed payment; (2) an upfront, variable payment; and (3) a monthly 
payment of varying amount depending on the number of Medicare 
beneficiaries historically attributed to the ACO. Payments to selected 
ACOs will begin at the start of the first performance year and end at 
the settlement scheduled at the end of that performance year in June 
2014. In most cases, advance payments will be recouped through the 
ACO's earned shared savings. An ACO that does not complete the full 
agreement period and does not earn shared savings will be required to 
repay the advance payment.
    Organizations must be accepted for participation in the Medicare 
Shared Savings Program before they can be considered for the Advance 
Payment Model. For more information on the Medicare Shared Savings 
Program see the Medicare Shared Savings Program final rule published 
elsewhere in this issue of the Federal Register. Additional information 
about the initiative and the application process is available on the 
Innovation Center Web site at https://www.innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.

III. Collection of Information Requirements

    Section 1115A(d)(3) of the Act provides that the requirements of 
the Paperwork Reduction Act of 1995 do not apply to the testing and 
evaluation or expansion of new payment and service delivery models 
under section 1115A of the Act.

    Authority: Section 1115A of the Social Security Act.

    Dated: October 6, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-27458 Filed 10-20-11; 11:15 am]
BILLING CODE 4120-01-P