New and Pending Demonstration Project Proposals Submitted Pursuant to Section 1115(a) of the Social Security Act; July 1995

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[ORD-080-N]

New and Pending Demonstration Project Proposals Submitted

Pursuant to Section 1115(a) of the Social Security Act; July 1995

AGENCY: Health Care Financing Administration (HCFA).

ACTION: Notice.

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SUMMARY: This notice lists new proposals for Medicaid demonstration

projects submitted to the Department of Health and Human Services

during the month of July 1995 under the authority of section 1115 of

the Social Security Act. This notice also lists proposals that were

approved, disapproved, pending, or withdrawn during this time period.

(This notice can be accessed on the Internet at HTTP://WWW.SSA.GOV/

HCFA/HCFAHP2.HTML.)

COMMENTS: We will accept written comments on these proposals. We will,

if feasible, acknowledge receipt of all comments, but we will not

provide written responses to comments. We will, however, neither

approve nor disapprove any new proposal for at least 30 days after the

date of this notice to allow time to receive and consider comments.

Direct comments as indicated below.

ADDRESSES: Mail correspondence to: Susan Anderson, Office of Research

and Demonstrations, Health Care Financing Administration, Mail Stop C3-

11-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.

FOR FURTHER INFORMATION CONTACT: Susan Anderson (410) 786-3996.

SUPPLEMENTARY INFORMATION:

I. Background

Under section 1115 of the Social Security Act (the Act), the

Department of Health and Human Services (HHS) may consider and approve

research and demonstration proposals with a broad range of policy

objectives. These demonstrations can lead to

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improvements in achieving the purposes of the Act.

In exercising her discretionary authority, the Secretary has

developed a number of policies and procedures for reviewing proposals.

On September 27, 1994, we published a notice in the Federal Register

(59 FR 49249) that specified (1) the principles that we ordinarily will

consider when approving or disapproving demonstration projects under

the authority in section 1115(a) of the Act; (2) the procedures we

expect States to use in involving the public in the development of

proposed demonstration projects under section 1115; and (3) the

procedures we ordinarily will follow in reviewing demonstration

proposals. We are committed to a thorough and expeditious review of

State requests to conduct such demonstrations.

As part of our procedures, we publish a notice in the Federal

Register with a monthly listing of all new submissions, pending

proposals, approvals, disapprovals, and withdrawn proposals. Proposals

submitted in response to a grant solicitation or other competitive

process are reported as received during the month that such grant or

bid is awarded, so as to prevent interference with the awards process.

II. Listing of New, Pending, Approved, and Withdrawn Proposals for the

Month of July 1995

A. Comprehensive Health Reform Programs

1. New Proposals

The following comprehensive health reform proposals were received

during the month of July:

Demonstration Title/State: Better Access for You (BAY) Health Plan

Demonstration--Alabama.

Description: Alabama proposes to create a mandatory managed care

delivery system in Mobile County for non-institutionalized Medicaid

beneficiaries and an expansion population of low-income women and

children. The network, called the Bay Health Network, would be

administered by the PrimeHealth Organization, which is owned by the

University of South Alabama Foundation. The State also proposes to

expand family planning benefits for pregnant women whose income is less

than 133 percent of the Federal poverty level.

Date Received: July 10, 1995.

State Contact: Vicki Huff, Director, Managed Care Division, Alabama

Medicaid Agency P.O. Box 5624, Montgomery, AL 36103-5624, (334) 242-

5011

Federal Project Officer:

Maria Boulmetis Health Care Financing Administration Office of

Research and Demonstrations Mail Stop C3-18-26, 7500 Security

Boulevard Baltimore, MD 21244-1850

Demonstration Title/State: Section 1115 Demonstration Waiver for

Medicaid Expansion--Utah.

Description: Utah proposes to expand eligibility for Medicaid to

all individuals with incomes up to 100 percent of the Federal poverty

level (subject to limited cost sharing) and to enroll all Medicaid

beneficiaries in managed care plans. The State also proposes to

streamline eligibility and administrative processes and to develop a

subsidized small employer health insurance plan.

Date Received: July 5, 1995.

State Contact:

Michael Deily, Acting Division Director, Utah Department of Health,

Division of Health Care Financing, 288 North 1460 West, P.O. Box

142901, Salt Lake City, UT 84114-2901, (801) 538-6406.

Federal Project Officer:

David Walsh, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

2. Pending Proposals

Demonstration Title/State: Arizona Health Care Cost Containment

System (AHCCCS)--Arizona.

Description: Arizona proposes to expand eligibility under its

current section 1115 AHCCCS program to individuals with incomes up to

100 percent of the Federal poverty level.

Date Received: March 17, 1995.

State Contact:

Mabel Chen, M.D., Director, Arizona Health Care Cost Containment

System, 801 East Jefferson, Phoenix, AZ 85034, (602) 271-4422.

Federal Project Officer:

Joan Peterson, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: MediPlan Plus--Illinois.

Description: Illinois seeks to develop a managed care delivery

system using a series of networks, either local or statewide, to tailor

its Medicaid delivery system to the needs of local urban neighborhoods

or large rural areas.

Date Received: September 15, 1994.

State Contact:

Tom Toberman, Manager, Federal/State Monitoring, 201 South Grand

Avenue East, Springfield, IL 62763, (217) 782-2570.

Federal Project Officer:

Gina Clemons, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Community Care of Kansas--Kansas.

Description: Kansas proposes to implement a ``managed cooperation

demonstration project'' in four predominantly rural counties, and to

assess the success of a non-competitive managed care model in rural

areas. The demonstration would enroll persons currently eligible in the

Aid to Families with Dependent Children (AFDC) and AFDC-related

eligibility categories, and expand Medicaid eligibility to children

ages 5 and under with family incomes up to 200 percent of the Federal

poverty level.

Date Received: March 23, 1995.

State Contact:

Karl Hockenbarger, Kansas Department of Social and Rehabilitation

Services, 915 Southwest Harrison Street, Topeka, KS 66612, (913)

296-4719.

Federal Project Officer:

Jane Forman, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-21-04, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Kentucky Health Care Partnership--

Kentucky.

Description: Kentucky proposes to enroll all non-institutional

AFDC, AFDC-related, and aged, blind, and disabled Medicaid-eligible

individuals in regional managed care networks operated by a sole-source

contractor. The proposed start date of the demonstration is December 1,

1995.

Date Received: June 19, 1995.

State Contact:

Larry A. McCarthy, Director, Program Development and Budget,

Department of Medicaid Services, 275 East Main Street, Frankfort, KY

40621, (406) 444-4540.

Federal Project Officer:

Maria Boulmetis, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Louisiana Health Access--Louisiana.

Description: Louisiana proposes to implement a fully capitated

statewide managed care program. A basic benefit package and a

behavioral health and pharmacy wrap-around would be administered

through the managed care plans. The State intends to expand Medicaid

eligibility to persons with incomes up to 250 percent of the Federal

poverty level; those with

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incomes above 133 percent of the Federal poverty level would pay all or

a portion of premiums.

Date Received: January 3, 1995.

State Contact:

Carolyn Maggio, Executive Director, Bureau of Research and

Development, Louisiana Department of Health and Hospitals, P.O. Box

2870, Baton Rouge, LA 70821-2871, (504) 342-2964.

Federal Project Officer:

Gina Clemons, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Missouri.

Description: Missouri proposes to require Medicaid beneficiaries to

enroll in managed care delivery systems, and extend Medicaid

eligibility to persons with incomes below 200 percent of the Federal

poverty level. As part of the program, Missouri would create a fully

capitated managed care pilot program to serve non-institutionalized

persons with permanent disabilities on a voluntary basis.

Date Received: June 30, 1994

State Contact:

Donna Checkett, Director, Division of Medical Services, Missouri

Department of Social Services, P.O. Box 6500, Jefferson City, MO

65102-6500, (314) 751-6922.

Federal Project Officer:

Nancy Goetschius, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: The Granite State Partnership for Access

and Affordability in Health Care--New Hampshire Description: New

Hampshire proposes to extend Medicaid eligibility to adults with

incomes below the AFDC cash standard and to create a public insurance

product for low-income workers. The State also seeks to implement a

number of pilot initiatives to help redesign its health care delivery

system.

Date Received: June 14, 1994.

State Contact:

Barry Bodell, New Hampshire Department of Health and Human Services,

Office of the Commissioner, 6 Hazen Drive, Concord, NH 03301-6505,

(603) 271-4332.

Federal Project Officer:

Maria Boulmetis, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: The Partnership Plan--New York.

Description: New York proposes to move most of the currently

eligible Medicaid population and Home Relief (General Assistance)

populations from a primarily fee-for-service system to a managed care

environment. The State also proposes to establish special needs plans

to serve individuals with HIV/AIDS and certain children with mental

illnesses. The proposed enrollment date for Home Relief and AFDC

recipients is November 1, 1995, followed by a 1-year enrollment period

for the supplemental security income (SSI) population beginning January

1, 1997.

Date Received: March 17, 1995.

State Contact:

Richard T. Cody, Deputy Commissioner, Division of Health and Long

Term Care, 40 North Pearl Street, Albany, NY 12243, (518) 474-9132.

Federal Project Officer:

Debbie Van Hoven, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: SoonerCare--Oklahoma.

Description: Oklahoma proposes to implement a 5-year statewide

managed care demonstration using both fully and partially capitated

delivery systems. The emphasis of the program is to address access

problems in rural areas by encouraging the development of rural-based

managed care initiatives. The State will employ traditional fully

capitated managed care delivery models for urban areas and will

introduce a series of partial capitation models in the rural areas of

the State. All currently eligible, non-institutionalized Medicaid

beneficiaries will be enrolled during the first 2 years of the project.

Date Received: January 6, 1995.

State Contact:

Dr. Garth Splinter, Oklahoma Health Care Authority, Lincoln Plaza,

4545 North Lincoln Blvd., Suite 124, Oklahoma City, OK 73105, (405)

530-3439.

Federal Project Officer:

Helaine I. Fingold, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

3. Approved Conceptual Proposals (Awards of Waivers Pending)

No conceptual proposals were approved during the month of July.

4. Approved Grant Proposals (Award of Waivers Pending)

No grant proposals were awarded during the month of July.

5. Approved Proposals

The following proposal was approved during the month of July.

Demonstration Title/State: Health Access Plan Demonstration--

Vermont.

Description: Vermont will integrate Medicaid beneficiaries into

managed care plans and expand coverage to uninsured individuals up to

150 percent of the Federal poverty level. The State will also provide a

prescription drug benefit to low-income Medicare beneficiaries.

Date Received: February 24, 1995.

Date Approved: July 28, 1995.

State Contact:

Veronica Celani, Health Policy Director, Vermont Agency of Human

Services, 103 State Street, Waterbury, VT 05671, (802) 828-2949.

Federal Project Officer:

Sherrie Fried, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

6. Disapproved Proposals

No comprehensive health reform proposals have been disapproved

since January 1, 1993.

7. Withdrawn Proposals

No comprehensive health reform proposals were withdrawn during the

month of July.

B. Other Section 1115 Demonstration Proposals

1. New Proposals

No new proposals were received during the month of July.

2. Pending Proposals:

Demonstration Title/State: Alternatives in Medicaid Home Care

Demonstration--Colorado.

Description: Colorado proposes to conduct a pilot project that

eliminates the restriction on provision of Medicaid home health

services in locations other than the beneficiary's place of residence.

The proposal would also permit nursing aides to perform functions that

historically have been provided only by skilled nursing staff. Medicaid

beneficiaries participating in the project will be adults (including

both frail elderly clients and younger clients with disabilities) who

can live independently and self-direct their own care. The project

would provide for delegation of specific functions from nurses to

certified nurses aides, pay nurses for shorter supervision and

monitoring visits, and allow higher payments to aides performing

delegated nursing tasks. Currently, home health

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agency nursing and nurse aide services are paid on a per visit basis.

Each visit is approximately 2-4 hours in duration, and recipients must

require skilled, hands-on care.

Date Received: June 3, 1995.

State Contact:

Dann Milne, Director, Department of Health Care Policy and

Financing, 1575 Sherman Street, Denver, CO 80203-1714, (303) 866-

5912.

Federal Project Officer:

Phyllis Nagy, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-21-06, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Georgia's Children's Benefit Plan--

Georgia.

Description: Georgia submitted a section 1115 proposal entitled

``Georgia Children's Benefit Plan'' to provide preventive and primary

care services to children aged 1 through 5 living in families with

incomes between 133 percent and 185 percent of the Federal poverty

level. The duration of the project is 5 years with proposed project

dates of July 1, 1995 to June 30, 2000.

Date Received: December 12, 1994.

State Contact:

Jacquelyn Foster-Rice, Georgia Department of Medical Assistance, 2

Peachtree Street Northwest, Atlanta, GA 30303-3159, (404) 651-5785.

Federal Project Officer:

Maria Boulmetis, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: High Cost User Initiative--Maryland.

Description: Maryland proposes to implement an integrated case

management system for high-cost, high-risk Medicaid beneficiaries.

Date Received: July 8, 1994.

State Contact:

John Folkemer, Maryland Department of Health and Mental Hygiene,

Office of Medical Assistance Policy, 201 West Preston Street,

Baltimore, MD 21201, (410) 225-5206.

Federal Project Officer:

William Clark, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-21-06, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Family Planning Services Section 1115

Waiver Request--Michigan.

Description: Michigan seeks to extend Medicaid eligibility for

family planning services to all women of childbearing age with incomes

at or below 185 percent of the Federal poverty level, and to provide an

additional benefit package consisting of home visits, outreach services

to identify eligibility, and reinforced support for utilization of

services. The duration of the project is 5 years.

Date Received: March 27, 1995.

State Contact:

Gerald Miller, Director, Department of Social Services, 235 South

Grand Avenue, Lansing, MI 48909, (517) 335-5117.

Federal Project Officer:

Suzanne Rotwein, Ph.D., Health Care Financing Administration, Office

of Research and Demonstrations, Mail Stop C3-24-07, 7500 Security

Boulevard Baltimore, MD 21244-1850.

Demonstration Title/State: Montana Mental Health Access Plan--

Montana.

Description: Montana proposes to provide all mental health services

for current Medicaid-eligible individuals through managed care and to

expand Medicaid eligibility to persons with incomes up to 200 percent

of the Federal poverty level. Newly eligible individuals would receive

only mental health benefits, and would not be eligible for other health

services under the demonstration. A single statewide contractor would

provide the mental health services and also determine eligibility,

perform inspections, and handle credentialing.

Date Received: June 16, 1995.

State Contact:

Nancy Ellery, State Medicaid Director, Department of Social and

Rehabilitation Services, P.O. Box 4210, 111 North Sanders, Helena,

MT 59604-4210, (406) 444-4540.

Federal Project Officer:

Nancy Goetschius, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Family Planning Proposal--New Mexico.

Description: New Mexico proposes to extend Medicaid eligibility for

family planning services to all women of childbearing age with incomes

at or below 185 percent of the Federal poverty level.

Date Received: November 1, 1994.

State Contact:

Bruce Weydemeyer, Director, Division of Medical Assistance, P.O. Box

2348, Santa Fe, NM 87504-2348, (505) 827-3106.

Federal Project Officer:

Suzanne Rotwein, Ph.D., Health Care Financing Administration, Office

of Research and Demonstrations, Mail Stop C3-24-07, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: CHOICES--Citizenship, Health,

Opportunities, Interdependence, Choices and Supports--Rhode Island.

Description: Rhode Island proposes to consolidate all current State

and Federal funding streams for adults with developmental disabilities

under one program using managed care/managed competition.

Date Received: April 5, 1994.

State Contact:

Susan Babin, Department of Mental Health, Retardation, and

Hospitals, Division of Developmental Disabilities, 600 New London

Avenue, Cranston, RI 02920, (401) 464-3234.

Federal Project Officer:

Melissa McNiff, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-21-06, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Family Planning Services Eligibility

Requirements Waiver--South Carolina.

Description: South Carolina proposes to extend Medicaid coverage

for family planning services for 22 additional months to postpartum

women with monthly incomes under 185 percent of the Federal poverty

level. The objectives of the demonstration are to increase the number

of reproductive age women receiving either Title XIX or Title X funded

family planning services following the completion of a pregnancy,

increase the period between pregnancies among mothers eligible for

maternity services under the expanded eligibility provisions of

Medicaid, and estimate the overall savings in Medicaid spending

attributable to providing family planning services to women for 2 years

postpartum. The duration of the proposed project would be 5 years.

Date Received: May 4, 1995.

State Contact:

Eugene A. Laurent, Executive Director, State Health and Human

Services Finance Commission, P.O. Box 8206, Columbia, SC 29202-8206,

(803) 253-6100.

Federal Project Officer:

Suzanne Rotwein, Ph.D., Health Care Financing Administration, Office

of Research and Demonstrations, Mail Stop C3-24-07, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

Demonstration Title/State: Wisconsin.

Description: Wisconsin proposes to limit the amount of exempt funds

that may be set aside as burial and related expenses for SSI-related

Medicaid beneficiaries.

Date Received: March 9, 1994.

State Contact:

Jean Sheil, Division of Economic Support, Wisconsin Department of

Health and

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Social Services, 1 West Wilson Street, Room 650, P.O. Box 7850,

Madison, WI 53707, (608) 266-0613.

Federal Project Officer:

J. Donald Sherwood, Health Care Financing Administration, Office of

Research and Demonstrations, Mail Stop C3-16-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

3. Approved Conceptual Proposals (Award of Waivers Pending)

No conceptual proposals were awarded during the month of July.

4. Approved Proposals

No proposals were approved during the month of July.

5. Disapproved Proposals

No proposals were disapproved during the month of July.

6. Withdrawn Proposals

No proposals were withdrawn during the month of July.

IV. Requests for Copies of a Proposal

Requests for copies of a specific Medicaid proposal should be made

to the State contact listed for the specific proposal. If further help

or information is needed, inquiries should be directed to HCFA at the

address above.

(Catalog of Federal Domestic Assistance Program, No. 93.779; Health

Financing Research, Demonstrations, and Experiments.)

Dated: September 29, 1995.

Bruce C. Vladeck,

Administrator, Health Care Financing Administration.

[FR Doc. 95-24947 Filed 10-6-95; 8:45 am]

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