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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[ORD-082-N]

New and Pending Demonstration Project Proposals Submitted

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

October 1995.

AGENCY: Health Care Financing Administration (HCFA, HHS).

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice lists new proposals for Medicaid demonstration

projects submitted to the Department of Health and Human Services

during the month of October 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approved, disapproved, pending, or withdrawn during this time period.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 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 October 1995

A. Comprehensive Health Reform Programs

1. New Proposals

No new proposals were received during the month of October.

2. Pending Proposals

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: 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: The Georgia Behavioral Health Plan--

Georgia.

Description: Georgia proposes to provide behavioral health services

under a managed care system through a

[[Page 64441]]

section 1115 demonstration. The plan would be implemented by regional

boards that would contract with third party administrators to develop a

network of behavioral health providers. The currently eligible Medicaid

population would be enrolled in the program and would have access to a

full range of behavioral health services. Once the program realizes

savings, the State proposes to expand coverage to individuals who are

not otherwise eligible for Medicaid.

Date Received: September 1, 1995.

State Contact: Margaret Taylor, Coordinator for Strategic Planning,

Department of Medical Assistance, 1 Peachtree Street, NW, Suite 27-100,

Atlanta, GA 30303-3159, (404) 657-2012.

Federal Project Officer: Nancy Goetschius, Health Care Financing

Administration, Office of Research and Demonstrations, Mail Stop C3-18-

26, 7500 Security Boulevard, Baltimore, Maryland 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: 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 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.

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: State of Texas Access Reform (STAR)--

Texas.

Description: Texas is proposing a section 1115 demonstration that

will restructure the Medicaid program using competitive managed care

principles. A focal point of the proposal is to utilize local

governmental entities (referred to as Intergovernmental Initiatives

(IGIs)) and to make the IGI responsible for designing and administering

a managed care system in its region. Approximately 876,636 new

beneficiaries would be served during the 5-year demonstration in

addition to the current Medicaid population. Texas proposes to

implement the program in June 1996.

Date Received: September 6, 1995.

State Contact: Cathy Rossberg, State Medicaid Office, P.O. Box

13247, Austin, TX 78711, (512) 502-3224.

Federal Project Officer: Alisa Adamo, 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

[[Page 64442]]

(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.

3. Approved Conceptual Proposals (Awards of Waivers Pending).

No conceptual proposals were approved during the month of October.

4. Approved Grant Proposals (Award of Waivers Pending).

No grant proposals were awarded during the month of October.

5. Approved Proposals.

The following comprehensive health reform proposals were approved

during the month of October.

Demonstration Title/State: Kentucky Partnership Plan--Kentucky.

Description: The State was awarded a demonstration to implement the

``Kentucky Partnership Plan,'' an amendment to its original proposal.

Under the demonstration, the State will be divided into eight managed

care regions incorporating both public and private providers into a

single managed care network which will offer the standard State

Medicaid benefit package to all non-institutionalized Medicaid

beneficiaries. Mental health and long-term care services will continue

to be offered through the fee-for-service system.

Date Received: June 19, 1995.

Date Approved: October 6, 1995.

State Contact: Larry A. McCarthy, Commonwealth of Kentucky,

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

40621, (502) 564-8196.

Federal Contact: 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: SoonerCare--Oklahoma.

Description: Oklahoma will 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.

Date Approved: October 12, 1995.

State Contact: Leigh Brown, Oklahoma Health Care Authority, 4545

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

530-3269.

Federal Project Officer: Patricia Selinger, 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 were disapproved during

the month of October.

7. Withdrawn Proposals

No comprehensive health reform proposals were withdrawn during the

month of October.

B. Other Section 1115 Demonstration Proposals

1. New Proposals

The following proposal was received during the month of October:

Demonstration/Title: Medicaid Family Planning Services for Women

of Childbearing Age--Arkansas.

Description: Arkansas seeks to extend Medicaid eligibility for

family planning services only to postpartum women under 133 percent

of the Federal poverty level who would have lost benefits 60 days

after delivery. The demonstration will streamline the application

process for these women and make income requirements less stringent.

Women will be eligible for family planning benefits for 5 years or

the length of the demonstration.

Date Received: October 2, 1995.

State Contact: David Rickard, Arkansas Department of Human

Services, 329 Donaghey Building, P.O. Box 1437, Little Rock, AK

72203-1437, (501) 682-8650.

Federal Contact: Rosemarie Hakim, Ph.D, Health Care Financing

Administration, Office of Research and Demonstrations, Mail Stop C3-

24-07, 7500 Security Boulevard, Baltimore, MD 21244-1850.

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 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: Integrated Care and Financing Project

Demonstration--Colorado.

Description: Colorado proposes to conduct an Integrated Care and

Financing Project demonstration. Specifically, the Colorado

Department of Health Care Policy and Financing proposes to add

institutional and community-based long-term care services to a

health maintenance organization (HMO) and make the HMO responsible

for providing comprehensive medical and supportive services through

one capitated rate. The project would include all Medicaid

eligibility groups, including individuals with dual eligibility.

Date Received: September 28, 1995.

State Contact: Dann Milne, Office of Long-Term Care System

Development, State of Colorado Department of Health Care Policy and

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

5912.

Federal Contact: Melissa McNiff, Health Care Financing

Administration, Office of Research and Demonstrations, Mail Stop C3-

18-26, 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

[[Page 64443]]

Stop C3-18-26, 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 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 October.

4. Approved Proposals

The following proposal was approved during the month of October.

Demonstration Title/State: Demonstration of Integrated Care

Management Systems for High-Cost/High-Risk Medicaid Beneficiaries--

Maryland.

Description: Maryland is testing a new case management delivery

system for high-cost/high-risk Medicaid beneficiaries and those at risk

to become high-cost. The program seeks to maintain or improve access to

providers and the quality of the care provided. The demonstration also

should lower health care costs by reducing hospital readmission rates

and by maintaining patients in the lowest-cost medically appropriate

setting. The University of Maryland Baltimore County Center for Health

Program Development and Management, under contract to the State, is

responsible for the demonstration's operations.

Date Received: July 8, 1994.

Date Approved: October 6, 1995.

State Contact: Martin P. Wasserman, M.D., J.D., Department of

Health and Mental Hygiene, State of Maryland, 201 West Preston Street,

Baltimore, MD 21201, (410) 225-6500.

Federal Project Officer: William D. Clark, Health Care Financing

Administration, Office of Research and Demonstrations, Mail Stop C3-21-

06, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

5. Disapproved Proposals

No proposals were disapproved during the month of October.

6. Withdrawn Proposals

No proposals were withdrawn during the month of October.

[[Page 64444]]

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: December 8, 1995.

Bruce C. Vladeck,

Administrator, Health Care Financing Administration.

[FR Doc. 95-30559 Filed 12-14-95; 8:45 am]

BILLING CODE 4120-01-P