```

[Federal Register Volume 76, Number 73 (Friday, April 15, 2011)]
[Notices]
[Pages 21372-21373]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-9126]

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5055-N2]

Medicare Program; Solicitation for Proposals for the Medicare 
Community-Based Care Transitions Program

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

ACTION: Notice.

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

SUMMARY: This notice informs interested parties of an opportunity to 
apply to participate in the Medicare Community-based Care Transitions 
Program, which was authorized by section 3026 of the Affordable Care 
Act.

DATES: Proposals will be accepted on a rolling basis. Acceptable 
applicants will be awarded on an ongoing basis as funds permit.

FOR FURTHER INFORMATION CONTACT: Juliana Tiongson, (410) 786-0342 or by 
e-mail at [email protected].

ADDRESSES: Proposals should be mailed to the following address:

Centers for Medicare & Medicaid Services, Attention: Juliana Tiongson, 
7500 Security Boulevard, Mail Stop: C4-14-15, Baltimore, Maryland 
21244-1850.

SUPPLEMENTARY INFORMATION: 

I. Background

    Section 3026 of the Patient Protection and Affordable Care Act 
(Pub. L. 111-148, enacted on March 23, 2010) (Affordable Care Act) 
authorized the Medicare Community-based Care Transitions Program 
(CCTP). The goals of the CCTP are to improve the quality of care 
transitions, reduce readmissions for high risk Medicare beneficiaries, 
and document measurable savings to the Medicare program by reducing 
unnecessary readmissions. The CCTP is part of Partnership for Patients, 
a national patient safety initiative through which the Administration 
is supporting broad-based efforts to reduce harm caused to patients in 
hospitals and improve care transitions.

[[Page 21373]]

II. Criteria for Applicants

    We are seeking eligible organizations which are a subsection (d) 
hospital, as defined in section 1886(d)(1)(B) of the Social Security 
Act (the Act), with high readmission rates that partner with community-
based organizations (CBOs) or CBOs that provide care transition 
services. CBOs are defined as community-based organizations that 
provide care transition services across the continuum of care through 
arrangements with subsection (d) hospitals and whose governing bodies 
include sufficient representation of multiple health care stakeholders, 
including consumers.
    This program creates a source of funding for care transition 
services that effectively manage transitions from acute to community-
based settings and report specified process and outcome measures on 
their results. CBOs will be paid on a per eligible discharge basis for 
eligible Medicare beneficiaries at high risk for readmission, including 
those with multiple chronic conditions, depression, or cognitive 
impairments.
    In selecting CBOs to participate in the program, preference will be 
given to eligible entities that are Administration on Aging (AoA) 
grantees that provide concurrent care transition interventions with 
multiple hospitals and practitioners or entities that provide services 
to medically-underserved populations, small communities, and rural 
areas. The program will run for 5 years beginning April 11, 2011; 
however, participants will be awarded 2-year agreements that may be 
extended on an annual basis for the remaining 3 years based on 
performance.
    Applicants must identify root causes of readmissions and define 
their target population and strategies for identifying high risk 
patients. Applicants must also specify care transition interventions 
including strategies for improving provider communications in care 
transitions and improving patient activation. Lastly, applicants will 
be required to provide a budget including a per eligible discharge rate 
for care transition services, provide an implementation plan with 
milestones, and demonstrate prior experience with effectively managing 
care transition services and reducing readmissions.
    A competitive process will be used to select eligible 
organizations. We will accept proposals on a rolling basis. The program 
will continue through 2015.
    For specific details regarding the CCTP and the application 
process, please refer to the solicitation on the CMS Web site at http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313.

III. Application Information

    Please refer to file code [CMS-5055-N2] on the application. 
Proposals (an unbound original and 3 copies plus an electronic copy on 
CD-ROM) must be typed for clarity and should not exceed 30 double-
spaced pages, exclusive of cover letter, the executive summary, 
resumes, forms, and supporting documentation. Because of staffing and 
resource limitations, we cannot accept proposals by facsimile (FAX) 
transmission. Applicants may, but are not required to, submit a total 
of 10 copies to assure that each reviewer receive a proposal in the 
manner intended by the applicant (for example, collated, tabulated 
color copies). Hard copies and electronic copies must be identical.

IV. Eligible Organizations

    As discussed above, subsection (d) hospitals with high readmission 
rates that partner with CBOs or CBOs that provide care transition 
services are eligible to participate in the CCTP. We anticipate that a 
wide variety of interested parties may be eligible to form a CBO in 
order to apply in collaboration with other organizations to perform the 
responsibilities specified. CBOs may be characterized as physician 
practices, particularly primary care practices, a corporate entity that 
has a separate quality improvement organization (QIO) contract with CMS 
under Part B of title XI of the Act, in situations that will not result 
in or create the appearance of a conflict of interest between the QIO's 
review tasks under title XI and the corporate entity's role as a CBO, 
an Aging and Disability Resource Center, Area Agency on Aging, or other 
appropriate organization that meets the statutory definition at section 
3026(b)(1)(B) of the Act.

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

    Dated: December 27, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-9126 Filed 4-12-11; 11:15 am]
BILLING CODE 4120-01-P
```