[Federal Register: December 27, 2002 (Volume 67, Number 249)]
[Notices]
[Page 79122-79123]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27de02-110]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers For Medicare & Medicaid Services
[CMS-4055-N]
Medicare Program: National Medicare+Choice Risk Adjustment Public
Meeting--February 3, 2003
AGENCY: Centers for Medicare & Medicaid Services (CMS), Health and
Human Services.
ACTION: Notice of meeting.
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SUMMARY: This notice announces a national Medicare+Choice risk
adjustment public meeting for Medicare+Choice organizations, Medicare
capitated demonstration projects, PACE plans, Evercare plans, Social
Health Maintenance Organizations, Wisconsin Partnership program,
Minnesota Senior Health Options, providers, practitioners, and other
interested parties. The public meeting will provide updated information
on the final CMS-HCC (Hierarchical Condition Category) risk adjustment
model and risk adjustment data processing. This public meeting builds
on information provided at the January 16, 2002 public meeting held at
CMS, the draft model released on March 29, 2002, and the regional
training sessions held in June 2002.
DATES: The public meeting is scheduled for February 3, 2003 from 9 a.m.
until 5 p.m., e.s.t.
ADDRESSES: The public meeting will be held in the CMS Auditorium, 7500
Security Boulevard, Baltimore, Maryland, 21244-1850.
FOR FURTHER INFORMATION CONTACT: Bobbie Knickman at (410) 786-4161 or
bknickman@cms.hhs.gov. To submit public comments no later than February
18, 2003, 5 p.m., e.s.t., e-mail Angela Porter at aporter@cms.hhs.gov
or fax to (410) 786-1048.
SUPPLEMENTARY INFORMATION:
Background
The Balanced Budget Act of 1997 (BBA) (Pub. L. 105-33) expanded the
Medicare+Choice (M+C) program for
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Medicare beneficiaries. Under the BBA, the Secretary of Health and
Human Services (the Secretary) was required to implement a risk
adjustment methodology that adjusts M+C payments to account for
variations in per capita costs based on health status and other
demographic factors. The BBA also gave the Secretary the authority to
collect inpatient hospital data for discharges on or after July 1,
1997, and additional data for other services occurring on or after July
1, 1998. The Secretary developed an initial risk adjustment methodology
that incorporated only inpatient hospital data. As required by the BBA,
this methodology was implemented beginning on January 1, 2000.
Currently, only 10 percent of the M+C payment rate is risk adjusted
under the existing risk adjustment methodology, with the other 90
percent subject only to demographic adjustments. The Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
(BIPA), enacted in December 2000, stipulates that the risk adjustment
methodology for 2004 and succeeding years should be based on data from
inpatient hospital and ambulatory settings. The BIPA also contains a
provision that phases in future risk adjusted payments as follows: 30
percent in 2004; 50 percent in 2005; 75 percent in 2006; and 100
percent in 2007.
The collection of physician encounter data, which began on October
1, 2000, and hospital outpatient encounter data, which began on April
1, 2001, was suspended from May 25, 2001 through July 1, 2002. The
Secretary suspended the submission of physician and hospital outpatient
encounter data in May 2001 and directed us to develop a risk adjustment
approach that balanced payment accuracy with data burden. We worked
with M+C organizations, their associations, and other interested
parties to develop a risk adjustment approach that significantly
reduced the burden of data collection for M+C organizations compared to
the approach that was suspended in May of 2001. The result of this
effort was to reduce burden by approximately 98 percent. The reduction
in burden was accomplished by decreasing the number of data elements
submitted (from 50 to 5 elements), only requiring submission of
diagnoses that are needed for calculating payments, and creating a
simplified data submission format and processing system. The draft CMS-
HCC risk adjustment payment model was released on March 29, 2002. The
CMS-HCC risk adjustment payment model is a 61 disease group selected
significant disease model. Also released on March 29, 2002, was a file
of ICD-9-CM codes required to group diagnosis codes for risk
adjustment. On April 15, 2002, a reduced set of ICD-9-CM codes were
released to further simplify the collection of diagnoses. The Risk
Adjustment Processing System (RAPS) became operational on October 1,
2002. Submission of ambulatory risk adjustment data (physician and
hospital outpatient) resumed on October 1, 2002 for dates of service
beginning July 1, 2002. On March 28, 2003 we will announce the proposed
final version of the CMS-HCC risk adjustment payment model that affects
risk adjustment payment beginning January 2004 and incorporates
hospital inpatient, hospital outpatient and physician data.
This public meeting will cover proposed changes to the draft
version of the CMS-HCC risk adjustment model released on March 29,
2002. These changes include proposed adjustments to account for higher
costs for community-based enrollees, as well as proposed implementation
approaches for 2004. The meeting will focus on the risk adjustment
model and data collection and include the following topics:
[sbull] Proposed final version of the CMS-HCC risk adjustment
payment model.
[sbull] Frailty adjuster (soliciting public comment).
[sbull] Elimination of the lag between the data collection period
and payment (soliciting public comment).
[sbull] Risk adjustment data processing.
[sbull] Risk adjustment schedule.
A copy of the public meeting agenda is available at: http://www.aspenxnet.com/meetingagenda.htm
.
The agenda will include presentations by CMS staff, Aspen training
staff, as well as question and answer sessions. Written public comments
are preferred following the meeting and will be accepted until February
18, 2003, 5 p.m., e.s.t.
Registration
Registration for this public meeting is required and will be on a
first-come, first-serve basis, limited to three attendees per
organization.
This public meeting is intended for Medicare+Choice organizations,
Medicare capitated demonstration projects, PACE plans, Evercare plans,
Social Health Maintenance Organizations, Wisconsin Partnership program,
Minnesota Senior Health Options, providers, practitioners, and other
interested parties. A waiting list will be available for additional
requests. The registration deadline is January 29, 2003 at 5 p.m.,
e.s.t. Registration must be completed via the Internet at the following
Web site: http://www.aspenxnet.com/registration. A confirmation notice
with specific meeting location information will be sent to attendees
upon finalization of registration.
Persons who are not registered in advance will not be permitted
into the Federal Building and thus not be able to attend the public
meeting. Persons attending the public meeting will be required to show
photographic identification, preferably a valid driver's license,
before entering the building. Please note that if the public meeting is
cancelled, then a notice will be posted on our Web site (http://www.cms.hhs.gov
).
Attendees will be provided with meeting materials at the time of
the meeting. Meeting materials will be available at http://www.mcoservice.com
after February 3, 2003.
Written questions about meeting logistics or requests for meeting
materials after February 3, 2003 must be directed to: Kim Slaughter,
Aspen Systems Corporation, Telephone Number: (301) 519-5388, Fax
Number: (301) 519-6360, e-mail: encounterdata@aspensys.com.
Written public comments will be accepted until February 18, 2003, 5
p.m., e.s.t. Written public comments should be sent to Angela Porter at
aporter@cms.hhs.gov or fax to (410) 786-1048.
(Authority: Sections 1851 through 1859 of the Social Security
Act (42 U.S.C. 1395w-21 through 1395w-28)) (Catalog of Federal
Domestic Assistance Program No. 93.773 Medicare--Hospital Insurance
Program; and No. 93.774, Medicare-- Supplementary Medical Insurance
Program)
Dated: December 4, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 02-31410 Filed 12-26-02; 8:45 am]
BILLING CODE 4120-01-P