New and Pending Demonstration Project Proposals Submitted Pursuant to Section 1115(a) of the Social Security Act: January 1997 and Supplement to December 1996 Listing

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[ORD-097-N]

New and Pending Demonstration Project Proposals Submitted

Pursuant to Section 1115(a) of the Social Security Act: January 1997

and Supplement to December 1996 Listing

AGENCY: Health Care Financing Administration (HCFA).

ACTION: Notice.

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SUMMARY: This notice identifies proposals that were submitted under the

authority of section 1115 of the Social Security Act during the month

of January 1997. No proposals were approved, disapproved, or withdrawn

during this time period. The notice also identifies pending proposals

for the month of January 1997. In addition, it also identifies an

additional proposal received in December 1996 that we inadvertently

omitted in the December listing. (This notice can be accessed on the

Internet at HTTP://WWW.HCFA.GOV/ORD/ORDHP1.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. Supplement to December 1996 Listing of New Proposals

In the December 1996 listing published in the Federal Register (62

FR 8451), under Section II. Other Section 1115 Demonstration Proposals,

we inadvertently omitted the following new proposal:

[[Page 15188]]

Demonstration Title/State: South Dakota Quality Initiative--South

Dakota.

Description: The South Dakota Quality Initiative project is

designed to test the effectiveness and efficiency of replacing the

existing mandated nursing home survey and certification process under

the Omnibus Budget Reconciliation Act 1987 with a new system for

quality measurement and improvement for nursing facilities

participating in Medicare and Medicaid. Participation by nursing

facilities will be voluntary.

Date Received: December 12, 1996.

State Contact: Joan Bachman, Administrator, Office of Health Care

Facilities Licensure and Certification, South Dakota Department of

Health, 615 East 4th Street, C/O 500 East Capitol Avenue, Pierre, South

Dakota 57501, (605) 773-3356.

Federal Project Officer: Kay Lewandowski, Health Care Financing

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

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

III. Listing of New, Pending, Approved, Disapproved, and Withdrawn

Proposals for the Month of January 1997

A. Comprehensive Health Reform Care Programs

1. New Proposals

No new proposals were received during the month of January.

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: Jack Kelly, Arizona Health Care Cost Containment

System, 801 East Jefferson, Phoenix, AZ 85034, (602) 417-4680.

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 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: 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: 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: 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: Jackie Jung, Division of Medical Services, Missouri

Department of Social Services, P.O. Box 6500, Jefferson City, MO 65102-

6500, (314) 751-5178.

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: Community Care Systems--New Hampshire.

Description: The State submitted a revised proposal for ``Community

Care Systems.'' This system will provide capitated, managed acute care

services not included in the health plan service package. The State

proposed to implement this program in three phases: Phase 1 will enroll

AFDC and AFDC-related children and families; Phase 2 will enroll the

elderly population; and Phase 3 will enroll disabled adults and

disabled children. The current waiver request is for Phase 1 only.

Date Received: June 5, 1996.

State Contact: Terry Morton, Planning and Policy Development, State

of New Hampshire, Department of Health and Human Services, 6 Hazen

Drive, Concord, NH 03301-6505, (603) 271-4688.

Federal Project Officer: Cindy Shirk, Health Care Financing

Administration, Office of Research and Demonstrations, Office of State

Health Reform 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

[[Page 15189]]

(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: Ellen Anderson, Deputy Commissioner, Division of

Health and Long Term Care, 40 North Pearl Street, Albany, NY 12243,

(518) 474-5737.

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: Kay Ghahrermani, State Medicaid Office, P. O. Box

13247, Austin, TX 78711, (512) 424-6543.

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 (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: 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: State of Washington Medicaid Section

1115(a) Waiver Request--Washington.

Description: Under ``The State of Washington Medicaid Section

1115(a) Waiver Request,'' the State is requesting waivers of the 75/25

and lock-in requirements. The State's intent is for the demonstration

to subsume the current 1915(b) Healthy Options Program. The State is

planning innovations with encounter data, Medicaid HEDIS, and quality

measures for the disabled population.

Date Received: October 2, 1996.

State Contact: Fred Fisher, Medical Assistance Administration,

Department of Social and Health Services, P.O. Box 45500, Olympia,

Washington 98504-5500, (360) 586-6513.

Federal Project Officer: Nancy Goetschius, Health Care Financing

Administration, Office of Research & Demonstration, Office of State

Health Reform Demonstrations. Mail Stop C3-18-26, 7500 Security

Boulevard, Baltimore, MD 21244-1850.

3. Approved Conceptual Proposals

No conceptual proposals were approved during the month of January.

4. Approved Proposals

No proposals were approved during the month of January.

5. Disapproved Proposals

No proposals were disapproved during the month of January.

6. Withdrawn Proposals

No proposals were withdrawn during the month of January.

B. Other Section 1115 Demonstration Proposals

1. New Proposals

The following proposal was received during the month of January.

Demonstration Title/State: Minnesota Long-Term Care Facility

Waiver--Minnesota.

Description: The State of Minnesota has submitted a waiver

application to provide Medicare waivers to conduct a demonstration

related to the Medicare skilled nursing facility (SNF) benefit. This

demonstration would involve: (1) the elimination of the 3-day hospital

stay before Medicare pays for nursing home stays; (2) a change in

coverage policy relating to respiratory therapy to allow for Medicare

reimbursement for respiratory therapists in SNFs or in a home; (3)

elimination of the minimum data set assessment for nursing home

residents expected to stay in nursing facilities for fewer than 30

days; and (4) a change in coverage policy relating to waiving the

requirements according to which certified aides are authorized to feed

long-term care facility residents.

Date Received: January 6, 1997.

State Contact: Stephanie L. Schwartz, Minnesota Department of Human

Services, 444 Lafayette North, St. Paul, Minnesota 55155, (612) 297-

7198.

Federal Project Officer: Sam Brown, Health Care Financing

Administration, Office of Research and Demonstrations, Office of

Beneficiary and Program, R&D, Mail Stop C3-21-06, 75500 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

[[Page 15190]]

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 Project Officer: 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 ages 1 through 5 years 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: 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: 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: Rosemarie Hakim, Health Care Financing

Administration, Office of Research and Demonstrations, Mail Stop C3-24-

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

Demonstration Title/State: Continuing Care Networks (CCN)

Demonstration--Monroe County, New York.

Description: The CCN project is designed to test the efficiency and

effectiveness of financing and delivery systems which integrate

primary, acute and long term care services under combined Medicare and

Medicaid capitation payments. Participants will be both Medicare only,

and dually eligible Medicare/Medicaid beneficiaries, who are 65 or

older. Enrollment will be voluntary for all participants.

Date Received: July 1, 1996.

State Contact: C. Christopher Rush, Assistant Bureau Director,

Bureau of Long Term Care, Division of Health and Long Term Care, New

York State Department of Social Services, 40 North Pearl Street,

Albany, New York 12243-0001, (518) 473-5507.

Federal Project Officer: Kay Lewandowski, Health Care Financing

Administration, Office of Research and Demonstrations, Mail Stop C3-23-

04, 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: South Dakota Quality Initiative --South

Dakota.

Description: The South Dakota Quality Initiative project is

designed to test the effectiveness and efficiency of replacing the

existing mandated nursing home survey and certification process under

the Omnibus Budget Reconciliation Act of 1987 with a new system for

quality measurement and improvement for nursing facilities

participating in Medicare and Medicaid. Participation by nursing

facilities will be voluntary.

Date Received: December 12, 1996.

State Contact: Joan Bachman, Administrator, Office of Health Care

Facilities Licensure and Certification, South Dakota Department of

Health, 615 East 4th Street, C/O 500 East Capitol Avenue, Pierre, South

Dakota 57501, (605) 773-3356.

Federal Project Officer: Kay Lewandowski, Health Care Financing

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

06,

[[Page 15191]]

7500 Security Boulevard, Baltimore, Maryland 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.

Demonstration Title/State: Wisconsin Partnership Program--

Wisconsin.

Description: Wisconsin has submitted Medicare section 222

demonstration and Medicaid section 1115 waiver requests to implement

the ``Wisconsin Partnership Program'' in specific counties of the

State. This program will test two innovative models of care, one for

frail elderly and one for persons with disabilities, utilizing a multi-

disciplinary team to manage care. The team is to include the

beneficiary, a nurse practitioner, the beneficiary's choice of primary

care physician, and a social worker or independent living coordinator.

Consumer choice of care, settings and the manner of service delivery is

a key component of the program. The demonstration will test the use of

consumer-defined quality indicators to measure and improve the quality

of service provided to people who are elderly and people with

disabilities.

Date Received: February 28, 1996.

State Contact: Mary Rowin, State of Wisconsin, Department of Health

and Social Services, 1 West Wilson Street, P.O. Box 7850, Madison, WI

53707, (608) 261-8885.

Federal Contact: William Clark, Health Care Financing

Administration, Office of Research and Demonstrations, Office of

Beneficiary and Program Research and Demonstrations, Mail Stop C3-21-

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

3. Approved, Disapproved, and Withdrawn Proposals

There were no proposals approved, disapproved, or withdrawn during

the month of January.

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: February 28, 1997.

Barbara Cooper,

Acting Director, Office of Research and Demonstrations.

[FR Doc. 97-7987 Filed 3-28-97; 8:45 am]

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