80 FR 8323 - Medicare Program; Oncology Care Model: Request for Applications
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 80, Issue 31 (February 17, 2015)
Centers for Medicare & Medicaid Services
Federal Register Volume 80, Issue 31 (February 17, 2015)
| Page Range | 8323-8324 | |
| FR Document | 2015-03060 |
[Federal Register Volume 80, Number 31 (Tuesday, February 17, 2015)] [Notices] [Pages 8323-8324] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2015-03060] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5514-N] Medicare Program; Oncology Care Model: Request for Applications AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: This notice announces a request for applications (RFA) for organizations to participate in the Oncology Care Model (OCM) beginning in 2016. DATES: Letter of Intent Submission Deadline: As described on the CMS Innovation Center Web site at http://innovation.cms.gov/initiatives/Oncology-Care/, interested payers must submit a nonbinding letter of intent by 5:00 p.m. Eastern Daylight Time (EDT) on March 19, 2015. Interested practices must submit a nonbinding letter of intent by 5:00 p.m. EDT on April 23, 2015. Application Submission Deadline: Applications for payers and practices must be received by 5:00 p.m. EDT on June 18, 2015. Application materials and instructions are available at http://innovation.cms.gov/initiatives/Oncology-Care/. ADDRESSES: Letter of Intent forms must be submitted electronically in the PDF fillable format to [email protected]. Letters of Intent will only be accepted via email. Applicants that submit a timely, complete Letter of Intent will be sent an authenticated web link and password with which to access the electronic, web-based application. FOR FURTHER INFORMATION CONTACT: [email protected] for questions regarding the application process of OCM. 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 (CHIP) beneficiaries. We are committed to continuous improvement for Medicare, Medicaid and CHIP beneficiaries. The goal of the Oncology Care Model (OCM) is to improve the health outcomes for people with cancer, improve the quality of cancer care, and reduce spending for cancer treatment. We expect that physician practices selected for participation in the model will be able to transform care delivery for their patients undergoing chemotherapy, leading to improved quality of care for beneficiaries at a decreased cost to payers. Through this care transformation, practices participating in OCM can reduce Medicare expenditures while improving cancer care for Medicare Fee-for-Service (FFS) beneficiaries. Beneficiaries can experience improved health outcomes when health care providers work in a coordinated and person-centered manner. We are interested in partnering with payers and practitioners who are working to redesign care to deliver these aims. Episode-based payment approaches that reward practitioners who improve the quality of care they deliver, lower costs, and engage with quality and cost data that will inform their provision of care are potential mechanisms for CMS to further emphasize care coordination and enhanced care through practice transformation. OCM will test episode-based payment for oncology care, using a retrospective performance-based payment for an episode of chemotherapy. The request for applications (RFA) requests applications to test a model centered around a chemotherapy episode of care. For more details, see the RFA available on the Innovation Center Web site at http://innovation.cms.gov/initiatives/Oncology-Care/. II. Provisions of the Notice The Innovation Center is operating this model under the authority of section 1115A of the Social Security Act (the Act). This RFA is directed to physician practices that provide oncology care as well as public and other health care payers. The Innovation Center hopes to engage at least 100 physician practices that, in aggregate, will furnish care for approximately 175,000 cancer care episodes for Medicare beneficiaries over the course of this 5-year model. The Innovation Center sees the following as key opportunities within OCM:Promote shared decision-making, person-centered communication, evidence-based care, beneficiary access to care, and coordination across providers and settings. Reduce complications of cancer and cancer treatments, as well as associated costs, through advanced care planning, increased use of high-value treatments, and reduction of inappropriate payment incentives. Collect structured clinical data and integrate clinical trial enrollment into processes of care to facilitate quality improvement and accelerate clinical research. Support the development and reporting of meaningful outcome measures. Develop and monitor refined approaches to care delivery, which may improve the research infrastructure (for example, by facilitating improvement in the quality of evidence for existing therapies). Encourage delivery of care in the lowest-cost medically- appropriate setting. Refine a value-based payment system that encourages team- based care and workforce innovation. Participating practices must be able to meet the following practice requirements during the performance period: 1. Treat patients with therapies consistent with nationally recognized clinical guidelines. 2. Provide and attest to 24 hours a day, 7 days a week patient access to an appropriate clinician who has real-time access to practice's medical records. 3. Use of ONC-certified electronic health record (EHR) technology as described in the RFA. 4. Utilize data for continuous quality improvement. 5. Provide core functions of patient navigation. 6. Document a care plan that contains the 13 components in the Institute of Medicine Care Management Plan. Participating practices in OCM will continue to receive standard Medicare FFS payments during OCM episodes. [[Page 8324]] OCM will also provide an opportunity for participating practices to receive retrospective episode-based performance payments. After calculating the benchmark for each OCM participant, CMS will set a target price for chemotherapy episodes, which includes a discount. Participants whose Medicare expenditures are below the target price may receive semi-annual lump-sum performance-based payments, subject to the achievement of quality measures. In addition to the performance-based payments, participants will receive a Per-Beneficiary-Per-Month payment (PBPM) for Medicare beneficiaries with nearly all cancer types for each of the 6 months of the episode. The monthly PBPM payment is intended to pay for the enhanced services driven by the practice requirements, aimed at transforming practices towards comprehensive, person-centered, and coordinated care. The OCM PBPM is $160 per OCM beneficiary per month for the duration of each 6-month episode, and will remain constant for the 5-year model. OCM also aims to incorporate other payers in addition to Medicare, such as commercial insurers and state Medicaid agencies. Payers must also be able to meet the following requirements for participation in the model: 1. Commit to participation in OCM for its 5-year duration, and start performance period no later than 90 days after OCM-FFS' performance period. 2. Sign a Memorandum of Understanding with the Innovation Center. 3. Enter into agreements with physician practices participating in OCM that include requirements to provide high quality care. 4. Share model methodologies with the Innovation Center. 5. Provide payments to practices for enhanced services and performance as required in the RFA. 6. Align practice quality and performance measures with OCM, when possible. 7. Provide participating practices with aggregate and patient-level data about payment and utilization for their patients receiving care in OCM, at regular intervals. The OCM start date is expected to be in spring 2016. For more specific details regarding OCM (including the RFA), we refer applicants to the informational materials on the Innovation Center Web site at: http://innovation.cms.gov/initiatives/Oncology-Care/. 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 Act, as added by section 3021 of the Affordable Care Act (Pub. L. 111-148), 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 such models under this section. Consequently, this document need not 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: December 22, 2014. Marilyn Tavenner, Administrator, Centers for Medicare & Medicaid Services. [FR Doc. 2015-03060 Filed 2-12-15; 11:15 am] BILLING CODE 4120-01-P
![Federal Register / Vol. 80, No. 31 / Tuesday, February 17, 2015 / Notices 8323
published in the Federal Register, in FOR FURTHER INFORMATION CONTACT: section 1115A of the Social Security Act
text or Adobe Portable Document OncologyCareModel@cms.hhs.gov for (the Act). This RFA is directed to
Format (PDF). To use PDF you must questions regarding the application physician practices that provide
have Adobe Acrobat Reader, which is process of OCM. oncology care as well as public and
available free at the site. SUPPLEMENTARY INFORMATION: other health care payers. The Innovation
You may also access documents of the Center hopes to engage at least 100
Department published in the Federal I. Background physician practices that, in aggregate,
Register by using the article search The Center for Medicare and will furnish care for approximately
feature at: www.federalregister.gov. Medicaid Innovation (Innovation 175,000 cancer care episodes for
Specifically, through the advanced Center), within the Centers for Medicare Medicare beneficiaries over the course
search feature at this site, you can limit & Medicaid Services (CMS), was created of this 5-year model.
your search to documents published by to test innovative payment and service The Innovation Center sees the
the Department. delivery models to reduce program following as key opportunities within
expenditures while preserving or OCM:
John Tschida, enhancing the quality of care for • Promote shared decision-making,
Director, National Institute on Disability, Medicare, Medicaid, and Children’s person-centered communication,
Independent Living, and Rehabilitation Health Insurance Program (CHIP) evidence-based care, beneficiary access
Research.
beneficiaries. to care, and coordination across
[FR Doc. 2015–03122 Filed 2–13–15; 8:45 am] We are committed to continuous providers and settings.
BILLING CODE 4154–01–P improvement for Medicare, Medicaid • Reduce complications of cancer and
and CHIP beneficiaries. The goal of the cancer treatments, as well as associated
Oncology Care Model (OCM) is to costs, through advanced care planning,
DEPARTMENT OF HEALTH AND improve the health outcomes for people increased use of high-value treatments,
HUMAN SERVICES with cancer, improve the quality of and reduction of inappropriate payment
cancer care, and reduce spending for incentives.
Centers for Medicare & Medicaid
Services
cancer treatment. We expect that • Collect structured clinical data and
physician practices selected for integrate clinical trial enrollment into
[CMS–5514–N] participation in the model will be able processes of care to facilitate quality
to transform care delivery for their improvement and accelerate clinical
Medicare Program; Oncology Care patients undergoing chemotherapy, research.
Model: Request for Applications leading to improved quality of care for • Support the development and
AGENCY: Centers for Medicare & beneficiaries at a decreased cost to reporting of meaningful outcome
Medicaid Services (CMS), HHS. payers. Through this care measures.
transformation, practices participating • Develop and monitor refined
ACTION: Notice.
in OCM can reduce Medicare approaches to care delivery, which may
SUMMARY: This notice announces a expenditures while improving cancer improve the research infrastructure (for
request for applications (RFA) for care for Medicare Fee-for-Service (FFS) example, by facilitating improvement in
organizations to participate in the beneficiaries. the quality of evidence for existing
Oncology Care Model (OCM) beginning Beneficiaries can experience therapies).
in 2016. improved health outcomes when health • Encourage delivery of care in the
care providers work in a coordinated lowest-cost medically-appropriate
DATES: Letter of Intent Submission
and person-centered manner. We are setting.
Deadline: As described on the CMS interested in partnering with payers and • Refine a value-based payment
Innovation Center Web site at http:// practitioners who are working to system that encourages team-based care
innovation.cms.gov/initiatives/ redesign care to deliver these aims. and workforce innovation.
Oncology-Care/, interested payers must Episode-based payment approaches that Participating practices must be able to
submit a nonbinding letter of intent by reward practitioners who improve the meet the following practice
5:00 p.m. Eastern Daylight Time (EDT) quality of care they deliver, lower costs, requirements during the performance
on March 19, 2015. Interested practices and engage with quality and cost data period:
must submit a nonbinding letter of that will inform their provision of care 1. Treat patients with therapies
intent by 5:00 p.m. EDT on April 23, are potential mechanisms for CMS to consistent with nationally recognized
2015. further emphasize care coordination and clinical guidelines.
Application Submission Deadline: 2. Provide and attest to 24 hours a
enhanced care through practice
Applications for payers and practices day, 7 days a week patient access to an
transformation.
must be received by 5:00 p.m. EDT on OCM will test episode-based payment appropriate clinician who has real-time
June 18, 2015. Application materials for oncology care, using a retrospective access to practice’s medical records.
and instructions are available at http:// performance-based payment for an 3. Use of ONC-certified electronic
innovation.cms.gov/initiatives/ episode of chemotherapy. The request health record (EHR) technology as
Oncology-Care/. for applications (RFA) requests described in the RFA.
ADDRESSES: Letter of Intent forms must applications to test a model centered 4. Utilize data for continuous quality
be submitted electronically in the PDF around a chemotherapy episode of care. improvement.
fillable format to For more details, see the RFA available 5. Provide core functions of patient
tkelley on DSK3SPTVN1PROD with NOTICES
OncologyCareModel@cms.hhs.gov. on the Innovation Center Web site at navigation.
Letters of Intent will only be accepted http://innovation.cms.gov/initiatives/ 6. Document a care plan that contains
via email. Applicants that submit a Oncology-Care/. the 13 components in the Institute of
timely, complete Letter of Intent will be Medicine Care Management Plan.
sent an authenticated web link and II. Provisions of the Notice Participating practices in OCM will
password with which to access the The Innovation Center is operating continue to receive standard Medicare
electronic, web-based application. this model under the authority of FFS payments during OCM episodes.
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![8324 Federal Register / Vol. 80, No. 31 / Tuesday, February 17, 2015 / Notices
OCM will also provide an opportunity 4. Share model methodologies with DEPARTMENT OF HEALTH AND
for participating practices to receive the Innovation Center. HUMAN SERVICES
retrospective episode-based 5. Provide payments to practices for
performance payments. After enhanced services and performance as Administration for Children and
calculating the benchmark for each required in the RFA. Families
OCM participant, CMS will set a target 6. Align practice quality and
price for chemotherapy episodes, which performance measures with OCM, when Proposed Information Collection
includes a discount. Participants whose possible. Activity; Comment Request
Medicare expenditures are below the 7. Provide participating practices with
target price may receive semi-annual aggregate and patient-level data about Title: Uniform Project Description
lump-sum performance-based payment and utilization for their (UPD) Program Narrative Format for
payments, subject to the achievement of patients receiving care in OCM, at Discretionary Grant Application Forms.
quality measures. In addition to the regular intervals. OMB No.: 0970–0139.
performance-based payments, The OCM start date is expected to be Description: The proposed
participants will receive a Per- in spring 2016. information collection would renew the
Beneficiary-Per-Month payment (PBPM) For more specific details regarding Administration for Children and
for Medicare beneficiaries with nearly OCM (including the RFA), we refer Families (ACF) Uniform Project
all cancer types for each of the 6 months applicants to the informational Description (UPD). The UPD provides a
of the episode. The monthly PBPM materials on the Innovation Center Web uniform grant application format for
payment is intended to pay for the site at: http://innovation.cms.gov/ applicants to submit project information
enhanced services driven by the initiatives/Oncology-Care/. Applicants in response to ACF discretionary
practice requirements, aimed at are responsible for monitoring the Web funding opportunity announcements.
transforming practices towards site to obtain the most current ACF uses this information, along with
comprehensive, person-centered, and information available. other OMB-approved information
coordinated care. The OCM PBPM is
III. Collection of Information collections (Standard Forms), to
$160 per OCM beneficiary per month for
Requirements evaluate and rank applications. Use of
the duration of each 6-month episode,
the UPD helps to protect the integrity of
and will remain constant for the 5-year Section 1115A(d)(3) of the Act, as ACF’s award selection process. All ACF
model. added by section 3021 of the Affordable
OCM also aims to incorporate other discretionary grant programs are
Care Act (Pub. L. 111–148), states that required to use this application format.
payers in addition to Medicare, such as chapter 35 of title 44, United States
commercial insurers and state Medicaid An ACF application consists of general
Code (the Paperwork Reduction Act of information and instructions; the
agencies. Payers must also be able to 1995), shall not apply to the testing and
meet the following requirements for Standard Form 424 series, which
evaluation of models or expansion of requests basic information, budget
participation in the model: such models under this section.
1. Commit to participation in OCM for information, and assurances; the Project
Consequently, this document need not Description that requests the applicant
its 5-year duration, and start be reviewed by the Office of
performance period no later than 90 to describe how program objectives will
Management and Budget under the be achieved; a rationale for the project’s
days after OCM–FFS’ performance authority of the Paperwork Reduction
period. budgeted costs; and other assurances
Act of 1995 (44 U.S.C. 35). and certifications. Guidance for the
2. Sign a Memorandum of
Understanding with the Innovation Dated: December 22, 2014. content of information requested in the
Center. Marilyn Tavenner, Project Description is based in OMB
3. Enter into agreements with Administrator, Centers for Medicare & Circular 45 CFR 75.203.
physician practices participating in Medicaid Services. Respondents: Applicants to ACF
OCM that include requirements to [FR Doc. 2015–03060 Filed 2–12–15; 11:15 am] Discretionary Funding Opportunity
provide high quality care. BILLING CODE 4120–01–P Announcements.
ANNUAL BURDEN ESTIMATES
Number of Average
Number of Total burden
Instrument responses per burden hours
respondents hours
respondent per response
ACF Uniform Project Description ..................................................................... 4,850 1 60 291,000
Estimated Total Annual Burden to the Administration for Children and proper performance of the functions of
Hours: 291,000. Families, Office of Planning, Research the agency, including whether the
In compliance with the requirements and Evaluation, 370 L’Enfant information shall have practical utility;
of Section 506(c)(2)(A) of the Paperwork Promenade SW., Washington, DC 20447, (b) the accuracy of the agency’s estimate
Reduction Act of 1995, the Attn: ACF Reports Clearance Officer. of the burden of the proposed collection
tkelley on DSK3SPTVN1PROD with NOTICES
Administration for Children and Email address: infocollection@ of information; (c) the quality, utility,
Families is soliciting public comment acf.hhs.gov. All requests should be and clarity of the information to be
on the specific aspects of the identified by the title of the information collected; and (d) ways to minimize the
information collection described above. collection. burden information to be collected; and
Copies of the proposed collection of ACF specifically requests comments (d) ways to minimize the burden of the
information can be obtained and on: (a) Whether the proposed collection collection of information on
comments may be forwarded by writing of information is necessary for the respondents, including through the use
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Document Created: 2015-12-18 13:19:54
Document Modified: 2015-12-18 13:19:54
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice. | |
| Dates | Letter of Intent Submission Deadline: As described on the CMS Innovation Center Web site at http://innovation.cms.gov/initiatives/ Oncology-Care/, interested payers must submit a nonbinding letter of intent by 5:00 p.m. Eastern Daylight Time (EDT) on March 19, 2015. Interested practices must submit a nonbinding letter of intent by 5:00 p.m. EDT on April 23, 2015. | |
| Contact | [email protected] for questions regarding the application process of OCM. | |
| FR Citation | 80 FR 8323 |
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