68012 Federal Register / Vol. 76, No. 212 / Wednesday, November 2, 2011 / Notices 

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. 

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 http:// 

www.innovations.cms.gov/areas-offocus/seamless-and-coordinated-caremodels/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 http:// 

www.innovations.cms.gov/areas-offocus/seamless-and-coordinated-caremodels/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—http:// 

www.innovations.cms.gov/areas-offocus/seamless-and-coordinated-caremodels/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 http:// 

www.innovations.cms.gov/areas-offocus/seamless-and-coordinated-caremodels/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 

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