This policy applies to payments under both the demographic adjustment system and the PIP-DCG risk adjustment system. Explicit program guidance on the timing of this change in CY 2000 will be forthcoming. D. Treatment of Certain Demonstrations Certain demonstration projects involve the provision of care to special populations, such as the frail elderly. In the January 1999 notice, we announced that because of the unique features of these projects, we had decided to delay implementation of a risk adjusted payment system for organizations participating in these demonstrations until we had additional information. We continue to study refinements to the risk adjustment methodology that would address the special circumstances of these demonstrations.
Payment approaches that rely upon any of a number of possible data sources are under consideration.
We have begun collecting encounter data and survey-based data from the Evercare, PACE, and SHMO demonstrations. We are analyzing these data to help us assess the appropriateness of various payment approaches. The analyses will not be completed in time to apply any recommended refinements in CY 2001. As one of the most frequently billed inpatient diagnoses, CHF is unique in its prevalence and the degree to which it can be successfully managed on an outpatient basis. In response to the comments we have received on this matter, we have consulted with experts in CHF, disease management, and risk adjustment on whether and how payments could be refined to provide for recognition of outpatient management of CHF until a comprehensive risk adjustment model is ready for implementation in 2004.