81 FR 91174 - Medicare Program; Start-Up Funding in Support of the Vermont All-Payer Accountable Care Organization (ACO) Model-Cooperative Agreement
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 81, Issue 242 (December 16, 2016)
Centers for Medicare & Medicaid Services
Federal Register Volume 81, Issue 242 (December 16, 2016)
| Page Range | 91174-91175 | |
| FR Document | 2016-30269 |
[Federal Register Volume 81, Number 242 (Friday, December 16, 2016)] [Notices] [Pages 91174-91175] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-30269] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5521-N] Medicare Program; Start-Up Funding in Support of the Vermont All- Payer Accountable Care Organization (ACO) Model--Cooperative Agreement AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: The purpose of this notice is to announce issuance of the November 23, 2016 single-source cooperative agreement funding opportunity available solely to Vermont's Agency of Human Services in order to provide care coordination and bolster collaboration for practices and community-based health care providers as part of the Vermont All[dash]Payer Accountable Care Organization (ACO) Model. DATES: The performance period of the Vermont All-Payer ACO Model will begin on January 1, 2017, and conclude on December 31, 2022. FOR FURTHER INFORMATION CONTACT: Stephen Cha, (410) 786-1876. SUPPLEMENTARY INFORMATION: I. Background The Vermont All-Payer Accountable Care Organization Model (Model) is the Centers for Medicare & Medicaid Services' (CMS) new test within the Center for Medicare and Medicaid Innovation of an alternative payment model in which the major health care payers--Medicare, Medicaid, and commercial health care payers--incentivize health care value and quality under the same payment structure for health care providers throughout the state's care delivery system to transform health care for the entire state and its population. An Accountable Care Organization (ACO) is an entity formed by certain health care providers that accepts financial accountability for the overall quality and cost of medical care furnished to, and health of, beneficiaries attributed to the entity. CMS believes that states can be critical partners of the federal government and other health care payers to facilitate the design, implementation, and evaluation of community-centered health systems that can deliver significantly improved cost, quality, and population health performance results for all state residents, including Medicare, Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries. States have policy and regulatory authorities, as well as ongoing relationships with commercial healthcare payers, health plans, and health care providers that can accelerate delivery system reform. CMS has previously partnered with states to accelerate delivery system reform through initiatives such as the State Innovations Model (SIM). SIM provides state-based healthcare transformation efforts with funding to test the ability of states to utilize policy and regulatory levers to accelerate multi-payer health care transformation. Vermont, a SIM state awardee, approached CMS with a desire to include Medicare in the state's multipayer payment and care delivery model, and Vermont publicly released its proposal on January 25, 2016. CMS reviewed Vermont's proposal and determined that it met the necessary requirements to explore a potential Vermont-specific model in which Medicare aligns with Vermont's healthcare transformation efforts. In October 2016, CMS and the State of Vermont entered into the Vermont All-Payer Accountable Care Organization Model Agreement (``State Agreement'') to implement the Vermont All-Payer ACO Model. The Vermont All-Payer ACO Model will be a 6-year model beginning in 2017 and ending in 2022. As part of the Model, Vermont health care providers will participate in a Vermont-specific Medicare ACO initiative (the Vermont Medicare ACO Initiative), which is largely based on CMS' Next Generation ACO Model. CMS will provide one-time start-up funding in the amount of $9,500,000 to the State to assist Vermont health care providers with care coordination and bolster their collaboration with community-based resources. CMS will provide the start-up funding as a cooperative agreement funding opportunity available solely to Vermont's Agency of Human Services, as announced in this notice. More information about the Vermont All-Payer ACO Model can be found at https://innovation.cms.gov/initiatives/vermont-all-payer-aco-model/. Through the Model, CMS will test whether the quality of health care for Vermont residents improves and healthcare expenditures for beneficiaries across payers (including Medicare fee-for-service, Vermont Medicaid, Vermont commercial plans, and Vermont self-insured plans) decrease if--The aforementioned payers offer Vermont ACOs risk-based arrangements tied to health outcomes and healthcare expenditures; The majority of Vermont health care providers enter into such risk-based arrangements; and The majority of Vermont residents across payers are aligned to an ACO bound by these arrangements. CMS and Vermont aim for broad ACO participation throughout the state, across all the significant payers and the majority of the care delivery system, to make redesigning the entire care delivery system a rational business strategy for Vermont health care providers and payers. As set forth in the State Agreement, Vermont commits to achieving statewide health outcomes, financial targets, and ACO scale (percentage of Vermont residents [[Page 91175]] aligned to an ACO) targets--both for Medicare and across all significant healthcare payers. Additionally, CMS and Vermont aim for this Model to deliver meaningful improvements in the health of a state's entire population by transforming the relationships between and amongst care delivery and public health systems across Vermont. II. Provisions of the Notice The purpose of this notice is to announce a single source cooperative agreement funding opportunity in the amount of $9,500,000 available solely to Vermont's Agency of Human Services (AHS) to support care coordination and bolster collaboration for practices and community-based health care providers as part of the Vermont All[dash]Payer ACO Model. A single-source award to the AHS will enable CMS to provide assistance to Vermont for the following purposes: To connect Medicare fee-for-service beneficiaries with community-based resources, coordinate transitions across care settings with appropriate involvement of the Medicare fee-for-service beneficiaries' primary care providers, coordinate care across health care providers, support health promotion and self-management by Medicare fee-for-service beneficiaries, and support practice improvement and transformation. These activities are necessary for Vermont to achieve the health outcomes and financial goals required under the Vermont All-Payer ACO Model. CMS and Vermont believe the Vermont All-Payer ACO Model can support health care providers, including physicians in small practices, to succeed as health care moves from fee-for-service to value-based payment systems. Participation by health care providers and payers in the model will be voluntary, and CMS and Vermont expect to work closely together to achieve sufficient uptake. In particular, this Model is being implemented using the Secretary's authority in section 1115A of the Social Security Act (the Act) and Vermont's Global Commitment to Health demonstration project authorized under section 1115 of the Act. Together these authorities make it possible for physicians and other clinicians in Vermont to participate the aligned and state-specific Vermont Medicare ACO Initiative and Medicaid ACO initiative. Under the Quality Payment Program, the two-sided risk portion of the Vermont Medicare ACO Initiative meets the criteria to be an Advanced Alternative Payment Model. Health care providers participating in the two-sided risk portion of the Vermont Medicare ACO Initiative may potentially qualify for the APM Incentive Payments starting in performance year 2018. This single-source funding opportunity to the AHS is designed to meet the goals of the cooperative agreement based on the AHS' existing knowledge and role in supporting the Model, its existing partnerships and collaborations with Vermont health care providers, and its resources and ability to deploy the funding immediately. III. Collection of Information Requirements This document does not impose information collection requirements, that is, reporting, recordkeeping or third-party disclosure requirements. Consequently, there is no need for review by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.). Dated: December 6, 2016. Andrew M. Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services. [FR Doc. 2016-30269 Filed 12-15-16; 8:45 am] BILLING CODE 4120-01-P
![91174 Federal Register / Vol. 81, No. 242 / Friday, December 16, 2016 / Notices
assets or the ownership of, control of, or available solely to Vermont’s Agency of multipayer payment and care delivery
the power to vote shares of a bank or Human Services in order to provide care model, and Vermont publicly released
bank holding company and all of the coordination and bolster collaboration its proposal on January 25, 2016. CMS
banks and nonbanking companies for practices and community-based reviewed Vermont’s proposal and
owned by the bank holding company, health care providers as part of the determined that it met the necessary
including the companies listed below. Vermont All-Payer Accountable Care requirements to explore a potential
The applications listed below, as well Organization (ACO) Model. Vermont-specific model in which
as other related filings required by the DATES: The performance period of the Medicare aligns with Vermont’s
Board, are available for immediate Vermont All-Payer ACO Model will healthcare transformation efforts. In
inspection at the Federal Reserve Bank begin on January 1, 2017, and conclude October 2016, CMS and the State of
indicated. The applications will also be on December 31, 2022. Vermont entered into the Vermont All-
available for inspection at the offices of FOR FURTHER INFORMATION CONTACT:
Payer Accountable Care Organization
the Board of Governors. Interested Stephen Cha, (410) 786–1876. Model Agreement (‘‘State Agreement’’)
persons may express their views in to implement the Vermont All-Payer
SUPPLEMENTARY INFORMATION:
writing on the standards enumerated in ACO Model. The Vermont All-Payer
the BHC Act (12 U.S.C. 1842(c)). If the I. Background ACO Model will be a 6-year model
proposal also involves the acquisition of beginning in 2017 and ending in 2022.
The Vermont All-Payer Accountable
a nonbanking company, the review also As part of the Model, Vermont health
Care Organization Model (Model) is the care providers will participate in a
includes whether the acquisition of the Centers for Medicare & Medicaid
nonbanking company complies with the Vermont-specific Medicare ACO
Services’ (CMS) new test within the initiative (the Vermont Medicare ACO
standards in section 4 of the BHC Act Center for Medicare and Medicaid
(12 U.S.C. 1843). Unless otherwise Initiative), which is largely based on
Innovation of an alternative payment CMS’ Next Generation ACO Model.
noted, nonbanking activities will be model in which the major health care
conducted throughout the United States. CMS will provide one-time start-up
payers—Medicare, Medicaid, and funding in the amount of $9,500,000 to
Unless otherwise noted, comments commercial health care payers—
regarding each of these applications the State to assist Vermont health care
incentivize health care value and providers with care coordination and
must be received at the Reserve Bank quality under the same payment
indicated or the offices of the Board of bolster their collaboration with
structure for health care providers community-based resources. CMS will
Governors not later than January 17, throughout the state’s care delivery
2017. provide the start-up funding as a
system to transform health care for the cooperative agreement funding
A. Federal Reserve Bank of St. Louis entire state and its population. An
(David L. Hubbard, Senior Manager) opportunity available solely to
Accountable Care Organization (ACO) is Vermont’s Agency of Human Services,
P.O. Box 442, St. Louis, Missouri an entity formed by certain health care
63166–2034. Comments can also be sent as announced in this notice. More
providers that accepts financial information about the Vermont All-
electronically to accountability for the overall quality
Comments.applications@stls.frb.org: Payer ACO Model can be found at
and cost of medical care furnished to, https://innovation.cms.gov/initiatives/
1. Farmers Bancorp, Inc., Blytheville, and health of, beneficiaries attributed to
Arkansas; to acquire 100 percent of vermont-all-payer-aco-model/.
the entity. Through the Model, CMS will test
Tennessee Bank & Trust, Nashville, CMS believes that states can be
Tennessee, a de nova bank. whether the quality of health care for
critical partners of the federal Vermont residents improves and
Board of Governors of the Federal Reserve government and other health care healthcare expenditures for
System, December 13, 2016. payers to facilitate the design, beneficiaries across payers (including
Yao-Chin Chao, implementation, and evaluation of Medicare fee-for-service, Vermont
Assistant Secretary of the Board. community-centered health systems that Medicaid, Vermont commercial plans,
[FR Doc. 2016–30301 Filed 12–15–16; 8:45 am] can deliver significantly improved cost, and Vermont self-insured plans)
BILLING CODE 6210–01–P
quality, and population health decrease if—
performance results for all state • The aforementioned payers offer
residents, including Medicare, Vermont ACOs risk-based arrangements
DEPARTMENT OF HEALTH AND Medicaid, and Children’s Health tied to health outcomes and healthcare
HUMAN SERVICES Insurance Program (CHIP) beneficiaries. expenditures;
States have policy and regulatory • The majority of Vermont health care
Centers for Medicare & Medicaid authorities, as well as ongoing providers enter into such risk-based
Services relationships with commercial arrangements; and
healthcare payers, health plans, and • The majority of Vermont residents
[CMS–5521–N] health care providers that can accelerate across payers are aligned to an ACO
Medicare Program; Start-Up Funding in delivery system reform. CMS has bound by these arrangements.
previously partnered with states to CMS and Vermont aim for broad ACO
Support of the Vermont All-Payer
accelerate delivery system reform participation throughout the state,
Accountable Care Organization (ACO)
through initiatives such as the State across all the significant payers and the
Model—Cooperative Agreement
Innovations Model (SIM). SIM provides majority of the care delivery system, to
Centers for Medicare & state-based healthcare transformation make redesigning the entire care
mstockstill on DSK3G9T082PROD with NOTICES
AGENCY:
Medicaid Services (CMS), HHS. efforts with funding to test the ability of delivery system a rational business
ACTION: Notice. states to utilize policy and regulatory strategy for Vermont health care
levers to accelerate multi-payer health providers and payers. As set forth in the
SUMMARY: The purpose of this notice is care transformation. State Agreement, Vermont commits to
to announce issuance of the November Vermont, a SIM state awardee, achieving statewide health outcomes,
23, 2016 single-source cooperative approached CMS with a desire to financial targets, and ACO scale
agreement funding opportunity include Medicare in the state’s (percentage of Vermont residents
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![Federal Register / Vol. 81, No. 242 / Friday, December 16, 2016 / Notices 91175
aligned to an ACO) targets—both for potentially qualify for the APM information collection for the proper
Medicare and across all significant Incentive Payments starting in performance of the agency’s functions;
healthcare payers. Additionally, CMS performance year 2018. the accuracy of the estimated burden;
and Vermont aim for this Model to This single-source funding ways to enhance the quality, utility, and
deliver meaningful improvements in the opportunity to the AHS is designed to clarity of the information to be
health of a state’s entire population by meet the goals of the cooperative collected; and the use of automated
transforming the relationships between agreement based on the AHS’ existing collection techniques or other forms of
and amongst care delivery and public knowledge and role in supporting the information technology to minimize the
health systems across Vermont. Model, its existing partnerships and information collection burden.
collaborations with Vermont health care DATES: Comments must be received by
II. Provisions of the Notice
providers, and its resources and ability February 14, 2017.
The purpose of this notice is to to deploy the funding immediately. ADDRESSES: When commenting, please
announce a single source cooperative
agreement funding opportunity in the III. Collection of Information reference the document identifier or
amount of $9,500,000 available solely to Requirements OMB control number. To be assured
Vermont’s Agency of Human Services consideration, comments and
This document does not impose
(AHS) to support care coordination and recommendations must be submitted in
information collection requirements,
bolster collaboration for practices and any one of the following ways:
that is, reporting, recordkeeping or
1. Electronically. You may send your
community-based health care providers third-party disclosure requirements.
comments electronically to http://
as part of the Vermont All-Payer ACO Consequently, there is no need for
Model. A single-source award to the www.regulations.gov. Follow the
review by the Office of Management and
AHS will enable CMS to provide instructions for ‘‘Comment or
Budget under the authority of the
assistance to Vermont for the following Submission’’ or ‘‘More Search Options’’
Paperwork Reduction Act of 1995 (44
purposes: To connect Medicare fee-for- to find the information collection
U.S.C. 3501 et seq.).
service beneficiaries with community- document(s) that are accepting
Dated: December 6, 2016. comments.
based resources, coordinate transitions
Andrew M. Slavitt, 2. By regular mail. You may mail
across care settings with appropriate
involvement of the Medicare fee-for- Acting Administrator, Centers for Medicare written comments to the following
service beneficiaries’ primary care & Medicaid Services. address: CMS, Office of Strategic
providers, coordinate care across health [FR Doc. 2016–30269 Filed 12–15–16; 8:45 am] Operations and Regulatory Affairs,
care providers, support health BILLING CODE 4120–01–P Division of Regulations Development,
promotion and self-management by Attention: Document Identifier/OMB
Medicare fee-for-service beneficiaries, Control Number ll Room C4–26–05,
and support practice improvement and DEPARTMENT OF HEALTH AND 7500 Security Boulevard, Baltimore,
transformation. These activities are HUMAN SERVICES Maryland 21244–1850.
necessary for Vermont to achieve the To obtain copies of a supporting
Centers for Medicare & Medicaid statement and any related forms for the
health outcomes and financial goals
Services proposed collection(s) summarized in
required under the Vermont All-Payer
ACO Model. [Document Identifiers: CMS–4040, CMS– this notice, you may make your request
CMS and Vermont believe the 10156, CMS–10170, CMS–10198, CMS– using one of following:
Vermont All-Payer ACO Model can 10227, CMS–10344, CMS–10501, CMS–R– 1. Access CMS’ Web site address at
support health care providers, including 266, and CMS–10282] http://www.cms.hhs.gov/
physicians in small practices, to PaperworkReductionActof1995.
succeed as health care moves from fee- Agency Information Collection 2. Email your request, including your
for-service to value-based payment Activities: Proposed Collection; address, phone number, OMB number,
systems. Participation by health care Comment Request and CMS document identifier, to
providers and payers in the model will Paperwork@cms.hhs.gov.
AGENCY: Centers for Medicare & 3. Call the Reports Clearance Office at
be voluntary, and CMS and Vermont Medicaid Services, HHS.
expect to work closely together to (410) 786–1326.
ACTION: Notice.
achieve sufficient uptake. In particular, FOR FURTHER INFORMATION CONTACT:
this Model is being implemented using SUMMARY: The Centers for Medicare & Reports Clearance Office at (410) 786–
the Secretary’s authority in section Medicaid Services (CMS) is announcing 1326.
1115A of the Social Security Act (the an opportunity for the public to SUPPLEMENTARY INFORMATION:
Act) and Vermont’s Global Commitment comment on CMS’ intention to collect
to Health demonstration project information from the public. Under the Contents
authorized under section 1115 of the Paperwork Reduction Act of 1995 (the This notice sets out a summary of the
Act. Together these authorities make it PRA), federal agencies are required to use and burden associated with the
possible for physicians and other publish notice in the Federal Register following information collections. More
clinicians in Vermont to participate the concerning each proposed collection of detailed information can be found in
aligned and state-specific Vermont information (including each proposed each collection’s supporting statement
Medicare ACO Initiative and Medicaid extension or reinstatement of an existing and associated materials (see
ACO initiative. Under the Quality collection of information) and to allow ADDRESSES).
mstockstill on DSK3G9T082PROD with NOTICES
Payment Program, the two-sided risk 60 days for public comment on the CMS–4040 Request for Enrollment in
portion of the Vermont Medicare ACO proposed action. Interested persons are Supplementary Medical Insurance
Initiative meets the criteria to be an invited to send comments regarding our CMS–10156 Retiree Drug Subsidy
Advanced Alternative Payment Model. burden estimates or any other aspect of (RDS) Application and Instructions
Health care providers participating in this collection of information, including CMS–10170 Retiree Drug Subsidy
the two-sided risk portion of the any of the following subjects: the (RDS) Payment Request and
Vermont Medicare ACO Initiative may necessity and utility of the proposed Instructions
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Document Created: 2018-02-14 09:07:31
Document Modified: 2018-02-14 09:07:31
| 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 | The performance period of the Vermont All-Payer ACO Model will begin on January 1, 2017, and conclude on December 31, 2022. | |
| Contact | Stephen Cha, (410) 786-1876. | |
| FR Citation | 81 FR 91174 |
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