80 FR 31040 - Medicare Program; Announcement of Request for Applications for the Million Hearts® Cardiovascular Risk Reduction Model

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 80, Issue 104 (June 1, 2015)

This notice informs interested parties of an opportunity to apply for participation in the Million Hearts[supreg] Cardiovascular Risk Reduction Model. The primary goal of this model is to test whether encouraging physician practices to calculate risk for all of the practice's eligible Medicare beneficiaries, using the American College of Cardiology/American Heart Association (ACC/AHA) Atherosclerotic Cardiovascular Disease (ASCVD) 10-year pooled cohort risk calculator will prevent the occurrence of first-time heart attacks and strokes.

[Federal Register Volume 80, Number 104 (Monday, June 1, 2015)]
[Notices]
[Pages 31040-31041]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-13042]



[[Page 31040]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5513-N]


Medicare Program; Announcement of Request for Applications for 
the Million Hearts[supreg] Cardiovascular Risk Reduction Model

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

ACTION: Notice.

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SUMMARY: This notice informs interested parties of an opportunity to 
apply for participation in the Million Hearts[supreg] Cardiovascular 
Risk Reduction Model. The primary goal of this model is to test whether 
encouraging physician practices to calculate risk for all of the 
practice's eligible Medicare beneficiaries, using the American College 
of Cardiology/American Heart Association (ACC/AHA) Atherosclerotic 
Cardiovascular Disease (ASCVD) 10-year pooled cohort risk calculator 
will prevent the occurrence of first-time heart attacks and strokes.

DATES: Applications will be considered timely if they are received on 
or before September 4, 2015 as outlined in the Request for Applications 
(RFA).

    Note:  Interested applicants will be required to submit a non-
binding Letter of Intent (LOI) to apply for the model.


ADDRESSES: All LOIs must be submitted electronically through the Center 
for Medicare and Medicaid Innovation Web site at: http://innovation.cms.gov/initiatives/Million-Hearts-CVDRRM/. LOIs will be 
accepted throughout the entire application period, ending September 4, 
2015. Applicants will need to use their LOI confirmation number to 
access the RFA. All applicants will receive a RFA submission 
confirmation number; it is the applicant's responsibility to retain a 
copy of the confirmation number for proof of submission.

FOR FURTHER INFORMATION CONTACT: Nina Brown at (410) 786-6103 or email 
address: [email protected]. The Center for Medicare and Medicaid 
Innovation Web site is at http://innovation.cms.gov/.

SUPPLEMENTARY INFORMATION: 

I. Background

    The Center for Medicare and Medicaid Innovation (Innovation 
Center), within the Centers for Medicare & Medicaid Services (CMS), was 
created to test innovative payment and service delivery models to 
reduce program expenditures while preserving or enhancing the quality 
of care for Medicare, Medicaid, and Children's Health Insurance Program 
beneficiaries.
    We are interested in models designed to improve care for specific 
populations. One population is Medicare fee-for service (FFS) 
beneficiaries 18 to 79 years of age who have never had a heart attack 
or stroke and who are not under hospice care. Current evidence suggests 
that preventive cardiovascular disease interventions can significantly 
reduce both adverse cardiovascular-related outcomes and death. The 
Million Hearts[supreg] Cardiovascular Risk Reduction Model (hereinafter 
referred to as ``CVD Risk Reduction Model'') seeks to test whether 
providing incentives for physician practices to calculate absolute 10-
year cardiovascular risk reduction, measured by the American College of 
Cardiology/American Heart Association (ACC/AHA) 10-year pooled cohort 
risk calculator, is effective in reducing heart attacks and strokes 
among Medicare FFS beneficiaries. Intervention group practices will 
engage in shared decision making, team-based care, and population 
health management to reduce beneficiaries' absolute risk. Intervention 
group practices will be required to submit quality data to CMS 
supported by a per-beneficiary-per-month payment.
    The Innovation Center is operating this model under the authority 
of section 1115A of the Social Security Act (the act) (42 U.S.C. 1315a) 
(as added by section 3021 of the Patient Protection and Affordable Care 
Act (Pub. L. 111-148), as amended by the Health Care and Education 
Reconciliation Act of 2010 (Pub. L. 111-152), (collectively known as 
Affordable Care Act)). We will evaluate whether this model reduces the 
occurrence of heart attacks and strokes as well as Medicare 
expenditures and enhances the quality of care furnished to Medicare 
beneficiaries.

II. Provisions of the Notice

    The RFA is directed to physician practices that include private 
practices, hospital-owned physician practices, large medical networks, 
hospital/physician organization, or independent practice associations. 
Up to 720 practices are expected to participate. Participating 
practices must meet the following requirements:
     Practices must have at least one practitioner. 
Practitioners are defined as Medical Doctors, Doctors of Osteopathic 
Medicine, Physician Assistants, and Nurse Practitioners.
     Practices must be using an Office of the National 
Coordinator for Health Information Technology (ONC) certified 
electronic health record (EHR) system.
     Participating physicians or other eligible professionals 
within the practice must have met the criteria for the Medicare EHR 
Incentive Programs in performance year 2015, also known as ``meaningful 
use,'' of an ONC certified electronic health record.
    Practices selected to participate will be randomized to the 
intervention group or the control group. Practices randomized to the 
control group will be required to submit data to CMS at the beginning 
of the first, second, third and fifth years of the model. Control group 
practices will receive a one-time payment of $20 per-beneficiary 
following the successful transmission of data to CMS on eligible 
beneficiaries within their practices. Practices randomized to the 
control group will receive no further funding beyond this one-time 
payment.
    Practices randomized to the intervention group will be paid a one-
time upfront payment of $10 per-beneficiary to conduct initial risk 
stratification for eligible beneficiaries in addition to a $10 per-
beneficiary-per-month fee for ongoing monitoring of high-risk FFS 
Medicare beneficiaries. Starting in the second year of the model, the 
$10 per-beneficiary-per-month ongoing fee is gradually placed at risk 
based on a practice's performance managing its ``high-risk'' 
beneficiaries.
    Intervention group practices in the CVD Risk Reduction Model will 
use the ACC/AHA Atherosclerotic Cardiovascular Disease (ASCVD) 10-year 
pooled cohort risk calculator to risk stratify Medicare FFS 
beneficiaries 18 to 79 years of age meeting the inclusion criteria. 
Practices will further identify whether beneficiaries are ``high-risk'' 
defined by their 10-year ASCVD risk score: A ``high risk,'' beneficiary 
is defined as a beneficiary with an ACC/AHA 10-year ASCVD risk score 
greater than or equal to 30 percent. Once the high risk beneficiaries 
have been identified, intervention group practices will engage in risk 
modification and report process and outcome measures of their results. 
Practices will be required to submit annual data to CMS through a 
certified Data Registry, which will be provided to participating 
practices by CMS.
    The CVD Risk Reduction Model period of performance is 5 years. 
Selected practices will enter into Model Participant Agreements with 
CMS. Applicants must present evidence that the applicant practices are 
capable of successfully identifying beneficiaries who meet the CVD Risk 
Reduction Model eligibility requirements.

[[Page 31041]]

Applicants must also demonstrate their plans for engaging in shared 
decision making activities with their beneficiaries. Applicants are 
required to submit to CMS general beneficiary data, the clinical 
indicators needed to calculate the 10-year ASCVD risk score, and the 
cardiovascular Physician Quality Reporting System (PQRS) measures as 
outlined in the RFA. Eligible practices will be selected on a first 
come, first served basis until all 720 spots have been filled. 
Applications must be submitted timely in the standard format outlined 
in the CVD Risk Reduction Model RFA in order to be considered for 
review. Applications that are not received in this format will not be 
considered for review.
    For more specific details regarding the CVD Risk Reduction Model 
(including the RFA), we refer applicants to the informational materials 
on the Innovation Center Web site at: http://innovation.cms.gov/initiatives/Million-Hearts-CVDRRM/. Applicants are responsible for 
monitoring the Web site to obtain the most current information 
available.

III. Collection of Information Requirements

    Section 1115A(d)(3) of the Social Security Act states that chapter 
35 of title 44, United States Code (the Paperwork Reduction Act of 
1995), shall not apply to the testing and evaluation of models or 
expansion of the models under this section. Consequently, there is no 
need for this document to be reviewed by the Office of Management and 
Budget under the authority of the Paperwork Reduction Act of 1995 (44 
U.S.C. 35).

    Dated: May 15, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-13042 Filed 5-28-15; 11:15 am]
 BILLING CODE 4120-01-P