Federal Register / Vol. 70, No. 179 / Friday, September 16, 2005 / Notices 54751 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–5017–N] 

Medicare Program; Medicare Health 

Care Quality (MHCQ) Demonstration 

Programs 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice informs eligible 

health care groups of an opportunity to 

apply to participate in the Medicare 

Health Care Quality demonstration. The 

goal of the demonstration is to improve 

the quality of care and services 

delivered to Medicare beneficiaries 

through a major system redesign that 

fosters best practice guideline usage, 

continuous quality and patient safety 

improvement, shared decision making 

between providers and patients, and the 

delivery of culturally and ethnically 

appropriate care. This notice contains 

information on how to obtain the 

complete solicitation and supporting 

information. 

A competitive process will be used to 

select 8 to 12 health care organizations 

(that is, physician group practices, 

integrated delivery systems, and 

regional coalitions of physician group 

practices and integrated delivery 

systems) to participate in the 5-year 

demonstration. The application 

solicitation will be conducted in two 

phases. 

DATES: For the initial solicitation, 

applications will be considered if 

received at the appropriate address, 

provided in the ADDRESSES section, no 

later than 5 p.m. e.s.t., on January 30, 

2006. For the second solicitation phase, 

applications will be considered if we 

receive them no later than 5 p.m. e.d.t., 

on September 29, 2006. Applicants 

intending to submit a proposal for the 

second phase review should forward a 

letter of intent to the same address listed 

in the ADDRESSES section of this notice, 

no later than January 30, 2006. 

LETTER OF INTENT REQUIREMENTS: The 

letter of intent should include the 

following: 

• An outline of the demonstration 

proposal. 

• A description of the proposed 

organizational structure. 

• A timeline for development and 

implementation of the proposed model. 

• A projected or desired date for 

submission of the application. 

This will enable us to—

1. Better plan for the second phase of 

the solicitation; 

2. Keep prospective applicants 

apprised of any new developments over 

the course of the solicitation process; 

and 

3. Ensure that they have the latest 

information for preparing their 

applications. 

ADDRESSES: Mail or deliver applications 

to the following address: 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 

mma646@cms.hhs.gov. Interested 

parties can obtain complete solicitation 

and supporting information on the CMS 

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

researchers/demos/mma646/. Paper 

copies can be obtained by writing to 

Cynthia Mason at the address listed in 

the ADDRESSES section of this notice. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 646 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA) (Pub. 

L. 108–173) amends title XVIII (42 

U.S.C. 1395 et seq.) of the Social 

Security Act (the Act) by establishing 

the Medicare Health Care Quality 

(MHCQ) Demonstration Programs. The 

MHCQ demonstration will test major 

changes to improve quality of care while 

increasing efficiency across an entire 

health care system. Broadly stated, the 

goals of the Medicare Health Care 

Quality demonstration are to—

• Improve patient safety; 

• Enhance quality; 

• Increase efficiency; and 

• Reduce scientific uncertainty and 

the unwarranted variation in medical 

practice that results in both lower 

quality and higher costs. 

The legislation anticipates that we can 

facilitate these overarching goals by 

providing incentives for system 

redesigns built on adoption and use of 

decision support tools by physicians 

and their patients, such as evidencebased medicine guidelines, best practice 

guidelines, and shared decision-making 

programs; reform of payment 

methodologies; measurement of 

outcomes; and enhanced cultural 

competence in the delivery of care. 

II. Provisions of This Notice 

The MHCQ demonstration will test 

the ability of health care groups to 

implement major system changes that 

reallocate resources to improve quality 

and reduce costs of Medicare Parts A, B, 

and C. Each proposal is expected to 

address all of the Institute of Medicine’s 

‘‘Six Aims for Improvement.’’ The 

proposed system redesign should: 

• Include steps to improve patient 

safety in the delivery of care, 

• Increase the effectiveness of the 

health care delivered, minimizing the 

over- and under-utilization of services 

Through the use of best practice 

guidelines and other measures, 

• Prioritize patient-centeredness in 

the delivery of care with primary focus 

on patients’ needs and comfort, 

Including increased emphasis on patient 

education and development of self-care 

skills, 

• Improve the timeliness of care, 

significantly reducing delay in the 

delivery of needed health care services, 

• Emphasize ways of improving 

efficiency in care delivery and thus 

improving quality, and 

• Assure equity of care for all 

persons. 

Further, we are persuaded that such 

system redesign should include the 

integration of health information 

technology consistent with the national 

health information infrastructure 

strategy and that—

• Informs clinical practice; 

• Interconnects clinicians; 

• Personalizes health care; and 

• Improves population health. 

We intend to use this demonstration 

to identify, develop, test, and 

disseminate major and multi-faceted 

improvements to the entire health care 

system. The focus will be on redesign 

projects that ‘‘bundle’’ multiple delivery 

improvements so as to introduce 

‘‘system-ness’’ across the spectrum of 

care delivery—changes across and even 

between organizations. The redesign 

must make the system patient-focused 

and must undo the effects of a payment 

methodology that systematically 

fragments care while encouraging both 

omissions and duplication of care. At its 

‘‘grandest,’’ particularly if a 

demonstration project is conducted by a 

regional coalition and entails the 

participation of other payers besides 

Medicare, this demonstration affords us 

and the awardees an opportunity to 

reinvent the health care delivery system. 

In keeping with our view that this 

demonstration authority is intended to 

test models of basic health care system 

redesign, including payment reform, we 

note that the statute provides broad 

authority for us to waive both payment 

and non-payment provisions of the 

Medicare program. Therefore, we are 

54752 Federal Register / Vol. 70, No. 179 / Friday, September 16, 2005 / Notices 

not specifying particular models of 

health care systems that demonstration 

applicants must propose and test, but 

are looking to applicants to specify the 

models they believe they can 

successfully put into practice for the 

patients they serve in their 

communities. 

As provided by applicable Federal 

statute, physician groups, integrated 

delivery systems, and organizations 

representing regional coalitions of 

physician groups or integrated delivery 

systems are eligible to apply. Integrated 

delivery systems must include a full 

range of health care providers including 

hospitals, clinics, home health agencies, 

ambulatory surgery centers, skilled 

nursing facilities, rehabilitation 

facilities and clinics, and employed, 

independent or contracted physicians. 

Eligible organizations and coalitions 

may form a new corporate entity for the 

purpose of representing provider 

organizations or eligible organizations 

may designate an existing entity as their 

representative. However, the entity 

organizing the coalition and developing 

the demonstration proposal must be an 

eligible provider organization. 

Payments under the MHCQ 

demonstration will be made for services 

furnished to Medicare beneficiaries and 

will be tied to cost savings, as well as 

improvements in process and outcome 

measures, increases in efficiencies, and 

reductions in costs in the targeted 

population compared to a similar group 

or sample. Eligible organizations may 

propose a variety of payment 

methodologies as long as those 

methodologies are amenable to an 

evaluation methodology based upon 

Medicare claims data. In addition, all 

proposals must assure budget neutrality 

and no duplication of payments for 

existing Medicare benefits. We will not 

be providing funding for start-up or 

other costs. 

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 July 31, 2006. 

Authority: Section 646 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA). 

(Catalog of Federal Domestic Assistance 

Program; No. 93.774, Medicare—

Supplementary Medical Insurance Program) 

Dated: May 19, 2005. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 05–18144 Filed 9–9–05; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Title: Annual Statistical Report on 

Children in Foster Homes and Children 

in Families Receiving Payment in 

Excess of the Poverty Income Level from 

a State Program Funded Under Part A of 

Title IV of the Social Security Act. 

OMB No.: 0970–0004. 

Description: The Department of 

Health and Human Services is required 

to collect these data under section 1124 

of Title I of the Elementary and 

Secondary Education Act, as amended 

by Pub. L. 103–382. The data are used 

by the U.S. Department of Education for 

allocation of funds for programs to aid 

disadvantaged elementary and 

secondary students. Respondents 

include various components of State 

Human Service agencies. 

Respondents: The 52 respondents 

include the 50 States, the District of 

Columbia and Puerto Rico. 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses 

per 

respondent 

Average 

burden 

hours per 

response 

Total burden hours 

Annual Statistical Report on Children in Foster Homes and Children Receiving Payments in Excess of the Poverty Level from a State Program Funded Under Part A 

of Title IV of the Social Security Act ............................................................................ 52 1 264.35 13,746 

Estimated Total Annual Burden 

Hours: 13,746. 

Additional Information: Copies of the 

proposed collection may be obtained by 

writing to the Administration for 

Children and Families, Office of 

Administration, Office of Information 

Services, 370 L’Enfant Promenade, SW., 

Washington, DC 20447, Attn: ACF 

Reports Clearance Officer. All requests 

should be identified by the title of the 

information collection. E-mail address: 

grjohnson@acf.hhs.gov. 

OMB Comment: OMB is required to 

make a decision concerning the 

collection of information between 30 

and 60 days after publication of this 

document in the Federal Register. 

Therefore, a comment is best assured of 

having its full effect if OMB receives it 

within 30 days of publication. Written 

comments and recommendations for the 

proposed information collection should 

be sent directly to the following: Office 

of Management and Budget, Paperwork 

Reduction Project, Attn: Desk Officer for 

ACF, E-mail address: 

Katherine_T._Astrich@omb.eop.gov. 

Dated: September 12, 2005. 

Robert Sargis, 

Reports Clearance, Officer. 

[FR Doc. 05–18442 Filed 9–15–05; 8:45 am] 

BILLING CODE 4184–01–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Office of Inspector General 

Program Exclusions: August 2005 

AGENCY: Office of Inspector General, 

HHS. 

ACTION: Notice of program exclusions. 

During the month of August 2005, the 

HHS Office of Inspector General 

imposed exclusions in the cases set 

forth below. When an exclusions is 

imposed, no program payment is made 

to anyone for any items or services 

(other than an emergency item or 

service not provided in a hospital 

emergency room) furnished, ordered or 

prescribed by an excluded party under