Federal Register / Vol. 69, No. 193 / Wednesday, October 6, 2004 / Notices 59929

CBA providers will be required to 

submit CBA Trimester Progress Reports 

(form A). The purpose of the CBA 

Trimester Progress Report is to describe 

CBA undertaken during the previous 

four months. The Trimester Progress 

Report will be a narrative on the 

programs’ successes and barriers; 

process and outcome monitoring data; 

collaborative and cooperative activities 

with other organizations; and plans for 

future activities. 

To effectively track and monitor all 

requests for capacity-building 

assistance, CBA providers will be 

required to submit a CBA Notification 

Form (form B) following each contact 

with a community based organization 

(CBO) or HIV prevention stakeholder for 

CBA services. The purpose of this form 

is to track all requests for services from 

CBOs, health departments and 

stakeholders. Requests for CBA from 

these CBOs and stakeholders are 

received by CBA providers on an ongoing basis. 

CBA providers will also be required to 

submit a CBA Completion Form (form 

C) following each episode of CBA 

service delivered to all CBOs and 

stakeholders. The purpose of this form 

is to provide feedback and follow-up 

information to CDC Project Officers on 

the types of CBA services and quality of 

services that were delivered to all CBOs 

by CBA providers. CBA requests from 

CBOs, health departments, and 

stakeholders are received by CBA 

providers on an on-going basis. 

Information collection will be on-going 

throughout the duration of the 

cooperative agreements.

In addition, CBA providers will be 

required to submit pre-planned CBA 

training events on a CBA Training 

Events Report (form D). The CBA 

Training Events Report is used to 

disseminate planned capacity building 

assistance activities delivered by CBA 

providers, the CDC and other 

organizations providing training and 

technical assistance. The calendar is 

also used as a marketing tool to let 

CBOs, health departments and 

stakeholders know what types of 

technical assistance and training 

activities are available. There are no 

costs to respondents other than their 

participation in the collection of 

information. The estimated annualized 

burden is 1,462 hours.

Form name Number of respondents 

Number of responses per 

respondent 

Average burden per response

(in hours) 

Form A: CBA Trimester Report .................................... 34 CBA Provider Grantees ........................................... 3 2 

Form B: CBA Notification Form .................................... 34 CBA Provider Grantees ........................................... 50 15/60 

Form C: CBA Completion Form ................................... 34 CBA Provider Grantees ........................................... 25 30/60 

Form D: CBA Training Events Form ............................ 34 CBA Provider Grantees ........................................... 12 1 

Dated: September 30, 2004. 

Alvin Hall, 

Director, Management Analysis and Services 

Office Centers for Disease Control and 

Prevention.

[FR Doc. 04–22454 Filed 10–5–04; 8:45 am] 

BILLING CODE 4163–18–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–5015–N] 

Medicare Program; Care Management 

for High-Cost Beneficiaries (CMHCB) 

Demonstration

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Notice.

SUMMARY: This notice informs eligible 

health care organizations of an 

opportunity to apply to implement and 

operate a care management 

demonstration serving high-cost 

beneficiaries in the original Medicare 

fee-for-service (FFS) program. This 

voluntary demonstration is part of an 

effort to develop and test multiple 

strategies to improve the coordination of 

Medicare services for high-cost FFS 

beneficiaries. The notice 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 

January 4, 2005.

ADDRESSES: Mail applications to—

Centers for Medicare & Medicaid 

Services, Attention: Cynthia Mason, 

Mail Stop: C4–17–27, 7500 Security 

Boulevard, Baltimore, Maryland 21244. 

Because of staff and resource 

limitations, we cannot accept 

applications by facsimile (FAX) 

transmission or by e-mail.

FOR FURTHER INFORMATION CONTACT:

Cynthia Mason at (410) 786–6680 or 

cmhcbdemo@cms.hhs.gov.

SUPPLEMENTARY INFORMATION: 

I. Background 

The Department of Health and Human 

Services is developing and testing 

multiple strategies to improve the 

coordination of Medicare services for 

beneficiaries with high-cost conditions. 

However, one approach that remains to 

be studied is intensive management for 

high-cost beneficiaries with various 

medical conditions to reduce cost as 

well as improve quality of care and 

quality of life for those beneficiaries. 

Therefore, we are interested in 

proposals to restructure care or enhance 

the management of care for beneficiaries 

with costly medical conditions. It is 

anticipated that organizations will serve 

high-risk beneficiaries with a variety of 

medical conditions and that the vast 

majority of beneficiaries participating in 

the demonstration will have multiple 

conditions. One organization will be 

selected per area to offer services to 

eligible beneficiaries. Beneficiary 

participation in the programs will be 

voluntary and will not change the 

amount, duration or scope of 

participants’ fee-for-service (FFS) 

Medicare benefits. FFS Medicare 

benefits will continue to be covered, 

administered, and paid under the 

traditional Medicare FFS program. 

Programs will be offered at no charge to 

the beneficiary. Organizations chosen 

for the demonstration will not be able to 

restrict beneficiary access to care (for 

example, there can be no utilization 

review or gatekeeper function) or 

restrict beneficiaries to a limited 

number of physicians in a network. 

Applicants may propose to serve one 

or more areas, but their proposed 

service areas must be adjusted to ensure 

that the population is of an appropriate 

size that would ensure statistically 

significant results. Also, to avoid any 

overlap between the current FFS care 

management demonstrations or the 

Chronic Care Improvement Programs 

(CCIP), it will be necessary to exclude 

from the Care Management for HighCost Beneficiaries (CMHCB) 

demonstration population any 

59930 Federal Register / Vol. 69, No. 193 / Wednesday, October 6, 2004 / Notices 

beneficiaries who meet the criteria to 

participate in existing demonstrations or 

CCIP. 

Organizations may be paid a monthly 

fee per participant or participate under 

a gain-sharing arrangement based on 

Medicare savings; however, fee and 

gain-sharing payments will be 

contingent on improvements in clinical 

quality of care, beneficiary and provider 

satisfaction, and savings to Medicare in 

the intervention groups compared to 

control groups.

II. Provisions of This Notice 

This demonstration is intended to test 

models of care management for highcost beneficiaries under the Medicare 

FFS program, incorporating relevant 

features from traditional disease 

management programs, but allowing 

sufficient flexibility for us and the 

awardees to adapt the design of CMHCB 

programs to meet the unique needs of 

the high-cost Medicare population. For 

some beneficiaries with high-cost 

conditions, the restructuring of the care 

management plan to integrate provider 

services in the program and to deliver 

those services in non-acute care 

locations such as the beneficiary’s home 

could significantly improve the 

beneficiary’s quality of life while 

simultaneously reducing costs. Under 

the CMHCB demonstration, we hope to 

test a variety of models such as 

intensive case management, increased 

provider availability, structured chronic 

care programs, restructured physician 

practices, and expanded flexibility in 

care settings to deliver care to high-cost 

beneficiaries with multiple conditions. 

The organization(s) that are awarded 

the demonstration project will be 

required to agree to assume financial 

risk in the event of failure to meet 

agreed upon performance guarantees for 

clinical quality, beneficiary and 

provider satisfaction and savings targets. 

That financial risk will include all fees 

and gain-sharing payments. 

Organizations eligible to apply to 

implement and operate care 

management programs under CMHCB 

include—

• Physician groups; 

• Hospitals; or 

• Integrated delivery systems.

Other organizations may apply, but 

only as part of a consortium that 

includes physician groups, hospitals, or 

integrated delivery systems that would 

play a major role in the operation of the 

proposed CMHCB demonstration. 

Eligible organizations must be capable 

of providing ambulatory health care 

services. 

We plan to make approximately four 

to six awards. Interested parties can 

obtain complete solicitation and 

supporting information on the CMS 

Web site at http://www.cms.hhs.gov/

researchers/demos/cmhcb.asp. Paper 

copies can be obtained by writing to 

Cynthia Mason at the address listed in 

the ADDRESSES section of this notice. 

III. Collection of Information 

Requirements 

This information collection 

requirement is 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 7/31/2006.

Authority: Section 402(a)(1)(B) and (a)(2) 

of the Social Security Amendments of 1967, 

Pub. L. 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: September 15, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 04–22459 Filed 10–1–04; 4:00 pm] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

Notice of Hearing: Reconsideration of 

Disapproval of New Hampshire State 

Plan Amendment (04–001A)

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Notice of hearing.

SUMMARY: This notice announces an 

administrative hearing on November 19, 

2004, at 10 a.m., JFK Federal Building, 

Room E275A, Boston, Massachusetts 

02203–0003, to reconsider the decision 

to disapprove New Hampshire State 

Plan Amendment (SPA) 04–001A.

DATES: Requests to participate in the 

hearing as a party must be received by 

the presiding officer by October 21, 

2004.

FOR FURTHER INFORMATION CONTACT:

Kathleen Scully-Hayes, Presiding 

Officer, CMS, LB–23–20, Lord Baltimore 

Drive, Baltimore, Maryland 21244, 

telephone: (410) 786–2055.

SUPPLEMENTARY INFORMATION: This 

notice announces an administrative 

hearing to reconsider the decision to 

disapprove New Hampshire State Plan 

Amendment (SPA) 04–001A, which 

New Hampshire submitted on March 31, 

2004. SPA 04–001A sought to reduce 

the Estimated Acquisition Cost (EAC) 

for prescription drugs from Average 

Wholesale Price (AWP) minus 12 

percent to AWP minus 16 percent and 

the dispensing fee from $2.50 to $1.75 

per prescription, effective for the period 

from January 12, 2004, to March 11, 

2004. The CMS reviewed this proposal 

and for the reasons set forth below, was 

unable to approve SPA 04–001A as 

submitted. 

At issue is whether the requested 

effective date of January 12, 2004, is 

consistent with statutory and regulatory 

requirements. In a separate action, CMS 

approved SPA 04–001B, which made 

the same changes in the EAC and 

dispensing fee calculations, effective 

March 12, 2004. Section 1902(a)(30) of 

the Social Security Act (the Act) 

requires a state’s Medicaid state plan to 

provide such methods and procedures 

as may be necessary to ensure that 

payments are consistent with efficiency, 

economy, and quality of care. Under 

that authority, the Secretary has issued 

regulations prescribing state rate-setting 

procedures. Federal regulations at 42 

CFR 447.205(d) require public notice to 

be issued prior to the effective date of 

a significant change in any methods and 

standards for setting payment rates for 

services. The state did not issue a public 

notice for the proposed changes in 

payment methodology until March 11, 

2004. Therefore, the earliest that such 

changes could be effective is March 12, 

2004. 

Based on the above, and after 

consultation with the Secretary as 

required under 42 CFR 430.15(c)(2), 

CMS disapproved New Hampshire SPA 

04–001A. 

Section 1116 of the Act and 42 CFR 

part 430 establish Departmental 

procedures that provide an 

administrative hearing for 

reconsideration of a disapproval of a 

State plan or plan amendment. The 

CMS is required to publish a copy of the 

notice to a state Medicaid agency that 

informs the agency of the time and place 

of the hearing and the issues to be 

considered. If we subsequently notify 

the agency of additional issues that will 

be considered at the hearing, we also 

will publish that notice. 

Any interested individual or group 

that wants to participate in the hearing 

as a party must petition the presiding 

officer within 15 days after publication 

of this notice, in accordance with the 

requirements contained at 42 CFR 

430.76(b)(2). Any person or organization 

that wants to participate as amicus