```

[Federal Register Volume 76, Number 165 (Thursday, August 25, 2011)]
[Notices]
[Pages 53137-53138]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-21707]

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5504-N]

Bundled Payments for Care Improvement Initiative: Request for 
Applications

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

ACTION: Notice.

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

SUMMARY: This notice announces a request for applications for 
organizations to participate in one or more of the initial four models 
under the Bundled Payments for Care Improvement initiative beginning in 
2012.

DATES: Letter of Intent Submission Deadlines: Interested organizations 
must submit a nonbinding letter of intent by September 22, 2011 for 
Model 1 and November 4, 2011 for Models 2 through 4 as described on the 
CMS Innovation Center Web site http://www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html. 
For applicants wishing to receive historical Medicare claims data in 
preparation for Models 2 through 4, a separate research request packet 
and data use agreement must be filed in conjunction with the Letter of 
Intent.
    Application Submission Deadlines: Applications must be received on 
or before October 21, 2011 for Model 1 and March 15, 2012 for Models 2 
through 4.

ADDRESSES: Letter of Intents and Applications should be submitted 
electronically in searchable PDF format via encrypted e-mail to the 
following e-mail address by the date specified in the DATES section of 
this notice: BundledPayments@cms.hhs.gov. Applications and appendices 
will only be accepted via e-mail.

FOR FURTHER INFORMATION CONTACT: BundledPayments@cms.hhs.gov for 
questions regarding the application process of the Bundled Payments for 
Care Improvement initiative.

SUPPLEMENTARY INFORMATION:

I. Background

    We are 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. Beneficiaries can experience improved 
health outcomes and patient experience when health care providers work 
in a coordinated and patient-centered manner. To this end, we are 
interested in partnering with providers who are working to redesign 
patient care to deliver these aims. Episode payment approaches that 
reward providers who take accountability for the three-part aim at the 
level of individual patient care for an episode are potential 
mechanisms for developing these partnerships.
    In order to provide a flexible and far-reaching approach towards 
episode-based care improvement, we are seeking proposals from health 
care providers who wish to align incentives between hospitals, 
physicians, and nonphysician practitioners in order to better 
coordinate care throughout an episode of care. This Bundled Payment for 
Care Improvement initiative request for applications (RFA) will test 
episode-based payment for acute care and associated post-acute care, 
using both retrospective and prospective bundled payment methods. The 
RFA requests applications to test models centered around acute care; 
these models will inform the design of future models, including care 
improvement for chronic conditions. For more details, see the RFA which 
is available on the Innovation Center Web site at http://www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html.

II. Provisions of the Notice

    Consistent with its authority under section 1115A of the Social 
Security Act (of the Act), as added by section 3021 of the Affordable 
Care Act, to test

[[Page 53138]]

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 Bundled Payments for Care 
Improvement initiative:
     Improve care coordination, patient experience, and 
accountability in a patient centered manner.
     Support and encourage providers who are interested in 
continuously reengineering care to deliver better care, better health, 
at lower costs through continuous improvement.
     Create a virtuous cycle that leads to continually 
decreasing the cost of an acute or chronic episode of care while 
fostering quality improvement.
     Develop and test payment models that create extended 
accountability for better care, better health at lower costs for acute 
and chronic medical care.
     Shorten the cycle time for adoption of evidence-based 
care.
     Create environments that stimulate rapid development of 
new evidence-based knowledge.
    The models to be tested based on applications to the RFA are as 
follows:
     Model 1: Retrospective payment models around the acute 
inpatient hospital stay only.
     Model 2: Retrospective bundled payment models for 
hospitals, physicians, and post-acute providers for an episode of care 
consisting of an inpatient hospital stay followed by post-acute care.
     Model 3: Retrospective bundled payment models for post-
acute care where the episode does not include the acute inpatient 
hospital stay.
     Model 4: Prospectively administered bundled payment models 
for the acute inpatient hospital stay only, such as prospective bundled 
payment for hospitals and physicians for an inpatient hospital stay
    Organizations are invited to submit proposals that define episodes 
of care in one or more of these four models. Proposals should 
demonstrate care improvement processes and enhancements such as 
reengineered care pathways using evidence-based medicine, standardized 
care using checklists, and care coordination. All models must encourage 
close partnerships among all of the providers caring for patients 
through the episode. Applicants must demonstrate robust quality 
monitoring and protocols to ensure beneficiary quality protection. 
Under all models, applicants must provide Medicare with a discount on 
Medicare fee-for-service expenditures.
    Bundled Payments for Care Improvement agreements will include a 
performance period of 3 years, with the possibility of extending an 
additional 2 years, beginning with the respective program date. The 
program start date may be as early as the first quarter of CY 2012 for 
awardees in Model 1.

III. Collection of Information Requirements

    Section 1115A(d) of the Act waives the requirements of the 
Paperwork Reduction Act of 1995 for the Innovation Center for purposes 
of testing new payment and service delivery models.

    Authority: 44 U.S.C. 3101.

    Dated: August 17, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-21707 Filed 8-23-11; 11:15 am]
BILLING CODE 4120-01-P
```