CMS Innovation Center Issues Request for Applications for Bundled Payment Program - August 24, 2011
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare & Medicaid Innovation (CMMI) announced a request for applications for a Medicare Bundled Payments for Care Improvement initiative on Aug. 23. The CMMI is seeking applications for four broadly defined models. Within the models, providers will have flexibility in selecting conditions to bundle, developing the health care delivery structure, and determining how payments will be allocated among participating providers.
Three of the proposed models are retrospective, meaning that CMS would make the usual Medicare FFS payments and reconcile the total payment for the episode against a predetermined target price (set by discounting costs for a similar episode of care based on historical data). Applicants may decide whether to define the episode of care as the acute care hospital stay only (Model 1), the acute care hospital stay plus post-acute care associated with the stay (Model 2), or just the post-acute care, beginning with the initiation of post-acute care services after discharge from the acute inpatient stay (Model 3). Model 4 is prospective, under which CMS would make a single, lump sum payment that would encompass all services furnished by the hospital, physicians and other practitioners during the inpatient hospital stay only. All models may include opportunities for gain-sharing among participating providers.
While the initiative is focused on Medicare payments, CMS will look favorably on applications that demonstrate partnerships with state Medicaid programs, private payers, or multipayer collaboratives to redesign care.
For Model 1, interested organizations must submit a nonbinding letter of intent by Sept. 22, 2011, and final applications must be received on or before October 21, 2011. For Models 2–4, a nonbinding letter of intent is due Nov. 4, 2011, and final applications must be received on or before March 15, 2012. More information and the request for applications are available.