4132 Federal Register / Vol. 70, No. 18 / Friday, January 28, 2005 / Notices 

C. Payment Rates 

The payment rates for demonstration 

services will be the same as under the 

physician fee schedule. 

D. Budget Neutrality 

The statute requires the Secretary to 

ensure that the aggregate payments 

made under the Medicare program do 

not exceed the amount that would have 

been paid under the Medicare program 

in the absence of this demonstration. 

Ensuring budget neutrality requires 

that the Secretary develop a strategy for 

recouping funds should the 

demonstration result in costs higher 

than would occur in the absence of the 

demonstration. We will first determine 

over the two-year demonstration 

whether the demonstration was budget 

neutral. If the demonstration is not 

budget neutral, we plan to meet the 

legislative requirements by making 

adjustments in the national chiropractor 

fee schedule to recover the costs of the 

demonstration in excess of the amount 

estimated to yield budget neutrality. We 

will assess budget neutrality by 

determining the change in costs based 

on a pre-post comparison of costs and 

the rate of change for specific diagnoses 

that are treated by chiropractors and 

physicians in the demonstration sites 

and control sites. We will not limit our 

analysis to reviewing only chiropractor 

claims because the costs of the 

expanded chiropractor services may 

have an impact on other Medicare costs. 

A CMS evaluation contractor will 

conduct the analysis of claims and 

budget neutrality. Since it will take 

approximately two years to complete 

the claims analysis, we anticipate that 

any necessary reduction will be made in 

the 2010 and 2011 fee schedules. If we 

determine that the adjustment for 

budget neutrality would be greater than 

two percent of the chiropractor fee 

schedule, we will implement the 

adjustment over a two-year period. 

However, if the adjustment is less than 

two percent of the chiropractor fee 

schedule, we will implement the 

adjustment over a one-year period. We 

will include the detailed analysis of 

budget neutrality and the proposed 

offset in the 2009 Federal Register

publication of the physician fee 

schedule. 

We invite comments regarding the 

appropriate methodology for 

determining budget neutrality. Written 

materials may be submitted by mail or 

e-mail to the addresses listed in the 

ADDRESSES section of this notice.

E. Site Selection 

The statute requires that this 

demonstration be conducted in four 

sites—two rural and two urban; one site 

in each type of area must be a health 

professional shortage area (HPSA). We 

have selected: 

• 26 northern counties in Illinois 

which includes Cook, Dekalb, DuPage, 

Grundy, Kane, Kendall, McHenry, Will, 

Boone, Bureau, Carroll, Henry, 

JoDaviess, Kankakee, Lake, LaSalle, Lee, 

Marshall, Mercer, Ogle, Putnam, Rock 

Island, Stark, Stephenson, Whiteside, 

and Winnebago, and Scott county in 

Iowa (urban); 

• 17 central HPSA counties in 

Richmond, Charlottesville, Lynchburg, 

and Danville MSAs in Virginia (urban 

HPSA)—the Virginia counties include 

Pittsylvania, Campbell, Appomattox, 

Nelson, Buckingham, Fluvanna, Louisa, 

Caroline, Hanover, New Kent, Henrico, 

Richmond City, Goochland, 

Cumberland, Powhatan, Amelia and 

Danville City; 

• New Mexico (rural HPSA); and 

• Maine (rural). 

We first grouped States by Medicare 

carriers, because we determined it was 

important that control and experimental 

sites should have the same carriers 

(since some carriers impose limits on 

chiropractor claims they approve). We 

then determined appropriate sites based 

on the following criteria: 

• Exclude States with restrictive 

practice regulations. 

• Exclude States that will not have 

transitioned to the MCS system in time 

for the demonstration. 

• Exclude States that are ranked in 

the top or bottom 5 values for two or 

more of the following six statistics:

—Medicare per capita claims costs 

—Medicare per capita chiropractic costs 

—Per user (patient) chiropractic costs 

based on carrier data 

—Chiropractic service users as a 

percentage of Part B beneficiaries

—Chiropractors per 10,000 State 

population 

—Chiropractors per 1,000 Part B 

beneficiaries

• Exclude States among those 

remaining that are served by a unique 

carrier and, thus, would lack a potential 

comparison site. 

• Each carrier group was assessed to 

determine its ability to support 

treatment and comparison groups for 

one or more types of sites. 

• Data was then used to estimate the 

number of beneficiaries residing in 

Urban/Rural and HPSA/non HPSA areas 

and determine which of the remaining 

States could support a demonstration 

site or sites. 

Few States had enough beneficiaries 

residing in HPSAs to be considered for 

one of the HPSA demonstration sites. 

III. Collection of Information 

Requirements 

This document does not impose 

information collection and recordkeeping requirements. Consequently, it 

does not need to be reviewed by the 

Office of Management and Budget under 

the authority of the Paperwork 

Reduction Act of 1995.

Authority: Section 651 of the Medicare 

Prescription Drug Improvement and 

Modernization Act of 2003 (Pub. L. 108–173).

(Catalog of Federal Domestic Assistance 

Program No. 93.778 and No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program)

Dated: December 17, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 05–1505 Filed 1–27–05; 8:45 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–5033–N2] 

Medicare Program; Meeting of the 

Advisory Board on the Demonstration 

of a Bundled Case-Mix Adjusted 

Payment System for End-Stage Renal 

Disease Services

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Notice.

SUMMARY: This notice announces the 

first public meeting of the Advisory 

Board on the Demonstration of a 

Bundled Case-Mix Adjusted Payment 

System for End-Stage Renal Disease 

(ESRD) Services. Notice of this meeting 

is required by the Federal Advisory 

Committee Act (5 U.S.C. App. 2, section 

10(a)(1) and (a)(2)). The Advisory Board 

will provide advice and 

recommendations with respect to the 

establishment and operation of the 

demonstration mandated by section 

623(e) of the Medicare Prescription 

Drug, Improvement, and Modernization 

Act of 2003. This notice also announces 

the appointment of eleven individuals 

to serve as members of the Advisory 

Board, including one individual to serve 

as co-chairperson, and one additional 

co-chairperson, who is employed by 

CMS.

DATES: The meeting is on February 16, 

2005 from 9 a.m. to 5 p.m., eastern 

standard time. 

Special Accomodations: Persons 

attending the meeting, who are hearing 

Federal Register / Vol. 70, No. 18 / Friday, January 28, 2005 / Notices 4133

or visually impaired, or have a 

condition that requires special 

assistance or accommodations, are 

asked to notify Pamela Kelly by 

February 8, 2005 by e-mail at 

ESRDAdvisoryBoard@cms.hhs.gov or by 

telephone at (410) 786–2461.

ADDRESSES: The meeting will be held at 

the Hyatt Regency, 300 Light Street, 

Baltimore, MD 21202. 

Attendance is limited to the space 

available, so seating will be on a first 

come, first served basis. 

Web site: Up-to-date information on 

this meeting is located at http://

www.cms.hhs.gov/faca/esrd.

Hotline: Up-to-date information on 

this meeting is located on the CMS 

Advisory Committee Hotline at 1 (877) 

449–5659 (toll free) or in the Baltimore 

area at (410) 786–9379.

FOR FURTHER INFORMATION CONTACT:

Pamela Kelly by e-mail at 

ESRDAdvisoryBoard@cms.hhs.gov or 

telephone at (410) 786–2461. The CMS 

Press Office at (202) 690–6145.

SUPPLEMENTARY INFORMATION: On June 2, 

2004, we published a Federal Register

notice requesting nominations for 

individuals to serve on the Advisory 

Board on the Demonstration of a 

Bundled Case-Mix Adjusted Payment 

System for End-Stage Renal Disease 

(ESRD) Services. The June 2, 2004 

notice also announced the 

establishment of the Advisory Board 

and the signing by the Secretary on May 

11, 2004 of the charter establishing the 

Advisory Board. This notice announces 

the first public meeting of this Advisory 

Board and the appointment of eleven 

individuals to serve as members of the 

Advisory Board on the Demonstration of 

a Bundled Case-Mix Adjusted Payment 

System for ESRD Services, including 

one individual to serve as cochairperson, and one additional cochairperson, who is employed by CMS. 

I. Members of the Advisory Board 

The Advisory Board on the 

Demonstration of a Bundled Case-Mix 

Adjusted Payment System for ESRD 

Services members are: Dr. Robert Rubin 

(Co-Chairperson), Clinical Professor of 

Medicine at Georgetown University 

School of Medicine; Dr. John Burkart, 

Professor of Internal Medicine/

Nephrology at Wake Forest University; 

Tom Cantor, Owner of Scantibodies 

Laboratory; Paula Cuellar, RN, Dialysis 

Care Center Director for the University 

of Chicago Hospitals; Paul Eggers, 

Program Director for Kidney and 

Urology Epidemiology, National 

Institute for Diabetes and Digestive and 

Kidney Diseases, National Institute of 

Health; Bonnie Greenspan, Health Care 

Consultant; Dr. Michael J. Lazarus, Chief 

Medical Officer and Senior Vice 

President of Clinical Quality, Fresenius 

Medical Care NA; Dr. William Owen, 

Adjunct Professor of Medicine, Duke 

University School of Medicine, and 

Senior Scholar, Fuqua School of 

Business; Nancy Ray, Research Director 

for the Medicare Payment Advisory 

Commission; Kris Robinson, Executive 

Director of the American Association of 

Kidney Patients; and Dr. Jay Wish, 

President of ESRD Networks 9 and 10. 

The Advisory Board will also be cochaired by Brady Augustine, a CMS 

employee. 

II. Topics of the Advisory Board 

Meeting 

The Advisory Board on the 

Demonstration of a Bundled Case-Mix 

Adjusted Payment System for ESRD 

Services will study and make 

recommendations on the following 

issues: 

• The drugs, biologicals, and clinical 

laboratory tests to be bundled into the 

demonstration payment rates. 

• The method and approach to be 

used for the patient characteristics to be 

included in the fully case-mix adjusted 

demonstration payment system. 

• The manner in which payment for 

bundled services provided by nondemonstration providers should be 

handled for beneficiaries participating 

in the demonstration. 

• The feasibility of providing 

financial incentives and penalties to 

organizations operating under the 

demonstration that meet or fail to meet 

applicable quality standards. 

• The specific quality standards to be 

used. 

• The feasibility of using disease 

management techniques to improve 

quality and patient satisfaction and 

reduce costs of care for the beneficiaries 

participating in the demonstration. 

• The selection criteria for 

demonstration organizations. 

III. Procedure and Agenda of the 

Advisory Board Meeting 

This meeting is open to the public. 

First, the appointees will be sworn in by 

a Federal Official. Each Advisory Board 

member will then be given the 

opportunity to make a self-introduction. 

The Advisory Board will hear 

background presentations from CMS. 

The Advisory Board will then deliberate 

openly on the general topic and will 

make recommendations on specific 

topics for future meetings. The Advisory 

Board will also allow a 30-minute open 

public session. Interested parties may 

speak or ask questions during the public 

comment period. Comments may be 

limited by the time available. Written 

questions should be submitted by 

February 8, 2005 to 

ESRDAdvisoryBoard@cms.hhs,gov.

Parties may also submit written 

comments following the meeting to the 

contact listed under the FOR FURTHER

INFORMATION CONTACT section of this 

notice.

Authority: 5 U.S.C. App. 2, section 10(a).

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program) 

Dated: January 26, 2005. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 05–1743 Filed 1–27–05; 8:45 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3150–N] 

Medicare Program; Meeting of the 

Medicare Coverage Advisory 

Committee—March 29, 2005

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Notice.

SUMMARY: This notice announces a 

public meeting of the Medicare 

Coverage Advisory Committee (MCAC). 

The Committee provides advice and 

recommendations about whether 

scientific evidence is adequate to 

determine whether certain medical 

items and services are reasonable and 

necessary under the Medicare statute. 

This meeting concerns usual care of 

chronic wounds. Notice of this meeting 

is given under the Federal Advisory 

Committee Act (5 U.S.C. App. 2, section 

10(a)).

DATES: The public meeting will be held 

on Tuesday, March 29, 2005 from 7:30 

a.m. until 4:30 p.m. e.s.t. 

Deadline for Presentations and 

Comments: Written comments and 

presentations must be received by 

February 3, 2005, 5 p.m., e.s.t. 

Special Accommodations: Persons 

attending the meeting who are hearing 

or visually impaired, or have a 

condition that requires special 

assistance or accommodations, are 

asked to notify the Executive Secretary 

by February 3, 2005 (see FOR FURTHER

INFORMATION CONTACT).

ADDRESSES: The meeting will be held in 

the auditorium at the Centers for