The Center for Medicare & Medicaid Innovation hosted an Open Door Forum (ODF) to allow dialysis facilities, nephrologists, other Medicare providers of services, suppliers, and other interested parties to ask questions on the revisions to the Request for Application (RFA) for the Comprehensive End Stage Renal Disease (ESRD) Care Initiative that was released on April 15, 2014.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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In this August 15, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Testing award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this July 26, 2012 webinar, CMS Innovation Center staff provided an overview of the State Innovation Models Initiative.
More information can be found at: http://innovations.cms.gov/initiatives/state-innovations/index.html.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Wednesday April 9, 2014 to provide an overview of the Medicare Care Choices Model and the application process. Subject matter experts from the CMS Innovation Center provided details and answered questions.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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The Next Generation ACO Model team hosted an open door forum on Tuesday, February 28, 2017. During this open door forum Model team members provided a deep dive presentation examining details of financial aspects relating to the model.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model final rule on Wednesday, February 22, 2017, from 12:00 p.m. – 1:00 p.m. EST. The final rule was displayed at the Federal Register on December 20, 2016 and is effective on February 18, 2017.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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Staff from the CMS Innovation Center and the Center for Medicare and CHIP Services hosted a webinar that provided an overview of the Strong Start initiative and the application process and requirements for the Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_overview.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Tuesday, June 10, 2014 from 12:00pm - 1:00pm EDT that focused on all components of the Round Two Model Test Award opportunity. The webinar also highlighted the requirements for submitting an application as well as considerations regarding the application review process.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this August 15, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Testing award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this July 26, 2012 webinar, CMS Innovation Center staff provided an overview of the State Innovation Models Initiative.
More information can be found at: http://innovations.cms.gov/initiatives/state-innovations/index.html.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Wednesday April 9, 2014 to provide an overview of the Medicare Care Choices Model and the application process. Subject matter experts from the CMS Innovation Center provided details and answered questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, February 28, 2017. During this open door forum Model team members provided a deep dive presentation examining details of financial aspects relating to the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model final rule on Wednesday, February 22, 2017, from 12:00 p.m. – 1:00 p.m. EST. The final rule was displayed at the Federal Register on December 20, 2016 and is effective on February 18, 2017.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Staff from the CMS Innovation Center and the Center for Medicare and CHIP Services hosted a webinar that provided an overview of the Strong Start initiative and the application process and requirements for the Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_overview.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Tuesday, June 10, 2014 from 12:00pm - 1:00pm EDT that focused on all components of the Round Two Model Test Award opportunity. The webinar also highlighted the requirements for submitting an application as well as considerations regarding the application review process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Wednesday, July 2, 2014, from 4:15pm-5:15pm EDT. The webinar reviewed Model Test Proposal Format Requirements, the ‘Population Health Plan’ Portion of the Model Test Project Narrative, and the Population Health Plan Deliverable of the Model Test Project Period.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The State Innovation Models initiative is a competitive funding opportunity for states to design and test multi-payer payment and service delivery models that deliver high-quality health care and improve health system performance.
- - -
CMS Innovations
http://innovation.cms.gov
We accept comments in the spirit of our comment policy: http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the sixth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, July 11, 2013 from 1:00–2:00pm EDT, focused on developing payment models.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This was the second event in a two-part webinar series on the Primary Care First Seriously Ill Population (SIP) payment model option. During this webinar, the Primary Care First Model Options team reviewed additional details about the SIP payment model option. This webinar built upon what was discussed during the first SIP webinar held on July 24, 2019 and provided an opportunity for attendees to submit live questions.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the fourth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, June 20, 2013 from 1:00–2:00pm EDT, focused on how to achieve lower costs through improvement. This webinar also reviewed the components of the Financial Plan.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center offered a kickoff webinar event for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Tuesday, May 31, 2016 from 4:00–5 p.m. EDT. This webinar focused on model objectives, terms of the award, eligibility criteria, changes from the first public solicitation and important deadlines. A 20 minute question and answer period followed the presentation.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Monday, March 3, 2014 to provide information on how to calculate budget neutrality for the five prongs in the Frontier Community Health Integration Project Demonstration. CMS also provided examples of ways that applicants can respond to the solicitation. Subject matter experts from the CMS Innovation Center and the Health Resources Services Administration (HRSA) provided details and answered questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this August 14, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Design award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted a repeat of the first open door forum in a series focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a Beneficiary Engagement and Incentives: Direct Decision Support (DDS) Model webinar regarding the model overview and Letter of Intent (LOI) process on Thursday, January 12, 2017 from 2:00 - 3:00 p.m. EST. At this event, attendees learned more about the DDS model, eligibility criteria, and LOI requirements.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held a Comprehensive Care for Joint Replacement Model webinar on proposed rule changes to the model on September 7, 2016.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The webinar introduced the Comprehensive Primary Care initiative to the primary care provider community and covered the service delivery model, including the 5 Comprehensive Primary Care functions, and the milestones participating practices will need to achieve in the first year. The process for applying was also discussed, including information about the application itself.
More at: http://innovations.cms.gov/resources/CPCi-Webinar-for-PCPs.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care First (KCF) Model Option introduction webinar on Friday, November 15, 2019 from 12:00 p.m. - 1:00 p.m. EST.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMS hosted an Open Door Forum call on November 22, 2013 to allow providers, suppliers, beneficiary advocacy groups, and other interested parties to provide input into the design and implementation of this demonstration. Mandated by the “Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 (P.L. 112-242)”, the purpose of this demonstration is to evaluate the impact of providing payment for items and services needed for the in-home administration of IVIG for the treatment of primary immune deficiency disease (PIDD). The demonstration will provide these benefits for up to 4,000 Medicare beneficiaries for a period of three years.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation hosted a webinar on Thursday, October 8, 2015. The webinar provided an opportunity to learn more about efforts to solicit public comment on a variety of alternative payment pathways to increase value over volume.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this Thursday, July 12, 2012 webinar, presentations focused on learning more about program requirements, preferences, and other keys to success from CMS Innovation Center staff and communities currently participating in the CCTP program. The final CCTP review panel for 2012 convened on September 20, 2012. Applications must have been received by September 3rd to be considered for this review. Future panels may be announced as funding permits.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.
The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs. Panelists include Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations; John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.
The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service. MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Wednesday, July 2, 2014, from 4:15pm-5:15pm EDT. The webinar reviewed Model Test Proposal Format Requirements, the ‘Population Health Plan’ Portion of the Model Test Project Narrative, and the Population Health Plan Deliverable of the Model Test Project Period.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The State Innovation Models initiative is a competitive funding opportunity for states to design and test multi-payer payment and service delivery models that deliver high-quality health care and improve health system performance.
- - -
CMS Innovations
http://innovation.cms.gov
We accept comments in the spirit of our comment policy: http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the sixth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, July 11, 2013 from 1:00–2:00pm EDT, focused on developing payment models.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This was the second event in a two-part webinar series on the Primary Care First Seriously Ill Population (SIP) payment model option. During this webinar, the Primary Care First Model Options team reviewed additional details about the SIP payment model option. This webinar built upon what was discussed during the first SIP webinar held on July 24, 2019 and provided an opportunity for attendees to submit live questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the fourth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, June 20, 2013 from 1:00–2:00pm EDT, focused on how to achieve lower costs through improvement. This webinar also reviewed the components of the Financial Plan.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center offered a kickoff webinar event for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Tuesday, May 31, 2016 from 4:00–5 p.m. EDT. This webinar focused on model objectives, terms of the award, eligibility criteria, changes from the first public solicitation and important deadlines. A 20 minute question and answer period followed the presentation.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Monday, March 3, 2014 to provide information on how to calculate budget neutrality for the five prongs in the Frontier Community Health Integration Project Demonstration. CMS also provided examples of ways that applicants can respond to the solicitation. Subject matter experts from the CMS Innovation Center and the Health Resources Services Administration (HRSA) provided details and answered questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this August 14, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Design award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted a repeat of the first open door forum in a series focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a Beneficiary Engagement and Incentives: Direct Decision Support (DDS) Model webinar regarding the model overview and Letter of Intent (LOI) process on Thursday, January 12, 2017 from 2:00 - 3:00 p.m. EST. At this event, attendees learned more about the DDS model, eligibility criteria, and LOI requirements.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held a Comprehensive Care for Joint Replacement Model webinar on proposed rule changes to the model on September 7, 2016.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The webinar introduced the Comprehensive Primary Care initiative to the primary care provider community and covered the service delivery model, including the 5 Comprehensive Primary Care functions, and the milestones participating practices will need to achieve in the first year. The process for applying was also discussed, including information about the application itself.
More at: http://innovations.cms.gov/resources/CPCi-Webinar-for-PCPs.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
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The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care First (KCF) Model Option introduction webinar on Friday, November 15, 2019 from 12:00 p.m. - 1:00 p.m. EST.
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CMS hosted an Open Door Forum call on November 22, 2013 to allow providers, suppliers, beneficiary advocacy groups, and other interested parties to provide input into the design and implementation of this demonstration. Mandated by the “Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 (P.L. 112-242)”, the purpose of this demonstration is to evaluate the impact of providing payment for items and services needed for the in-home administration of IVIG for the treatment of primary immune deficiency disease (PIDD). The demonstration will provide these benefits for up to 4,000 Medicare beneficiaries for a period of three years.
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The Center for Medicare and Medicaid Innovation hosted a webinar on Thursday, October 8, 2015. The webinar provided an opportunity to learn more about efforts to solicit public comment on a variety of alternative payment pathways to increase value over volume.
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In this Thursday, July 12, 2012 webinar, presentations focused on learning more about program requirements, preferences, and other keys to success from CMS Innovation Center staff and communities currently participating in the CCTP program. The final CCTP review panel for 2012 convened on September 20, 2012. Applications must have been received by September 3rd to be considered for this review. Future panels may be announced as funding permits.
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CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
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As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.
The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs. Panelists include Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations; John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.
The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service. MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.
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The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
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With more than 400,000 patients in the United States suffering from ESRD, and 100,000 more developing permanent kidney failure every year, the disease is exacting a significant toll on patients, their families, and on our health care system.
Efficacy of Dietary Intervention in END STAGE RENAL DISEASEJunaid Nazar
Chronic kidney disease (CKD), a major global public health problem, has been recognized as one of the eleven important causes of death (WHO, 2009). This review explores wide range of barriers related to patients and health systems involved in controlling the prevalence of CKD at the primary health care level.
The CMS Innovation Center held the second in a series of webinar events for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Wednesday, June 8, 2016 from 12:00p.m. – 1:30p.m. EDT. This webinar consisted of a panel discussion focusing on learning from past ESCO participants on what it takes to become a successful applicant and successful ESCO.
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In this webinar, staff from the CMS Innovation Center provided an overview of the Demonstration, and offered information about how to apply.
More at: http://www.innovations.cms.gov/resources/GNE_overview.html
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Staff from the CMS Innovation Center hosted an overview webinar of the Health Care Innovation Awards Round Two to give interested potential applicants the opportunity to hear more about the Funding Opportunity Announcement. CMS Innovation Center staff were also available to answer questions. Advance registration was required.
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The CMS Innovation Center held the seventh in a series of webinars on Thursday, July 18, 2013 from 1:00–2:00pm EDT to provide an overview of the application package.
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Strong Start is an initiative to reduce preterm births and early elective deliveries while improving outcomes for newborns and pregnant women.
Under this initiative, the Innovation Center will award up to $43 million through a competitive process to providers, States, managed care plans, and conveners to achieve better care, improved health, and lower costs for these women and their newborns.
CMS Innovation Center and Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can prepare their budget for the Strong Start Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_McaidFundOpp.html
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In this July 11, 2012 webinar, CMS Innovation Center staff discussed the amended Funding Opportunity Announcement (FOA) for the Strong Start for Mothers and Newborns initiative.
More at: http://www.innovations.cms.gov/resources/StrongStart_FOA.html
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The CMS Innovation Center is hosting a conference call to discuss important updates regarding the Strong Start funding opportunity. Due to numerous questions and suggestions we have received from stakeholders, CMS is revising the Funding Opportunity Announcement (FOA) to respond to the important issues stakeholders have raised. CMS will extend the application deadline to allow potential applicants the time they need to develop innovative models.
More at: http://www.innovations.cms.gov/resources/StrongStart_ConferenceCall.html
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CMS Innovation Center staff hosted this webinar for state officials to provide additional information on the application process, financial templates and accessing Medicare data.
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CMS Innovation Center staff hosted a webinar for state officials on Tuesday, August 28, 2012 from 3:00pm to 4:00pm ET to provide additional information on the application process, financial templates and accessing Medicare data.
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During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 11, 2019 from 1:30pm-3:00 p.m. EST entitled, Direct Contracting Overview/Direct Contracting Entity (DCE) Types/Alignment. During this webinar, presenters provided an overview of the Direct Contracting Model Professional and Global Options, including information about the participation and eligibility requirements, Direct Contracting Entity (DCE) types, payment mechanisms, and beneficiary alignment methodology.
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The Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted an introduction webinar about the Oncology Care Model (OCM) on Thursday, February 19, 2015 from 12:00pm – 1:00pm EST. The webinar focused on introducing core concepts of OCM and application instructions. Advance registration was not required.
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Compliance and Legal Risks in Laborist, Surgicalist, and Hospitalist Arrangem...MD Ranger, Inc.
Have you structured your hospital-based physician contracts to address all aspects of compliance?
Hospitalist agreements involve unique compliance and financial issues, particularly when global payments and advanced practice providers are involved. Risks include indirect compensation, billing and other compliance issues. This presentation will discuss compliance risks and provide guidance on how to structure compliant contracts and business arrangements.
The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care Contracting (CKCC) Model Options introduction webinar on Tuesday, November 12, 2019 from 12:00 p.m. - 1:00 p.m. EST.
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The Oncology Care Model team hosted a webinar on OCM Frequently Asked Questions and Application Overview on Wednesday, April 22, 2015 at 12:00pm EDT. No password was required for the webinar.
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The CMS Innovation Center held a Medicare Advantage Value-Based Insurance Design Model webinar on August 24, 2016 from 2:00 – 3:00p.m. EDT. This webinar provided an overview of the changes to the model scheduled to take effect in 2018.
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On Thursday, September 24, 2015, the Medicare Advantage Value-Based Insurance Design Model team hosted a webinar. Attendees received an overview of the model as well an opportunity for questions and answers about the model.
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During this webinar, a high-level overview of the ACO REACH Model was provided including information on the participation and eligibility requirements, Accountable Care Organization (ACO) types, payment mechanisms, and beneficiary alignment methodology.
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The Medicare Advantage Value-Based Insurance Design Model team presented a webinar discussing the CY2020 application cycle on Friday, January 25 from 4:00 p.m. to 5:00 p.m. EST.
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MECHANISMS OF PAYMENT
1. Private fee - for services
2. Post payment plans
3. Private third party prepayment plans
-Commercial insurance companies
-Non-profit health service corporations
-Prepaid group practice
-Capitation plans
4. Salary
5. Public programs
1. Private fee - for service
• The two party arrangement, traditional form of reimbursement for dental services.
• Integral part of private practice as a delivery method.
Advantages:
1) Culturally acceptable
2) Flexibility
3) Administratively simple
4) Can be used in expensive situations
Disadvantages:
1. Major percent of the population cannot afford dental care.
Post Payment Plans or Budget Plans
• First started in Late 1930's - local dental societies in Pennsylvania & Michigan
• Mechanisms for the individual purchase of service
Advantages:
1. Helpful for middle income people
2. Primarily used to finance prosthetic and other costly treatment
Disadvantages:
1. Lower income people cannot use to the full
2. Problem of defaulted loans
Private Third Party Prepayment Plans
Defined as payment for service by some agency rather than directly by the beneficiary of those services.
1st Party-Dentist; 2nd Party-Patient; 3rd Party-Administrator of Finances
Third Party/ Carrier/ Insurer/ Underwriter/ Administrative Agent.
• Defined as The party to a dental prepayment contract that may collect premiums, assume financial risk, pay claims and provide administrative services
Reimbursement of Dentist in Third Party Plans
The major forms of third-party reimbursement currently in use are:
Usual fee: The fee that an individual dentist most frequently charges for a given dental service.
Customary Fee: The fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure.
Reasonable Fee: the fee charged by the dentist for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complications may differ from the dentists usual fee or the benefit administrators customary fee.
A table of allowances: A list of covered services with an assigned amount that represents the total obligation of the plan with respect to payment for such service but that does not necessarily represent the dentists full fee for that service”.
Fee schedule: A list of charges established or agreed to by a dentist for specific dental services. A fee schedule is usually taken to represent payment in full, whereas a table of allowances may not.
Capitation: A capitation fee is usually a fixed monthly payment paid by a carrier to a dentist based on the number of patients assigned to the dentist for treatment.
SALARY
Dentists in some group practices, those in the armed forces and those employed by public agencies are salaried.
PUBLIC PROGRAMS
Medicare
Medicaid
NHI
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model proposals on Wednesday, August 31, 2016, from noon – 1:00 p.m. EDT.
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The CMS Innovation Center hosted a webinar on Tuesday, February 11, 2014 from 2:30 – 4:30pm EST that provided an overview of the demonstration and the application package.
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This Medicare-Medicaid ACO Model webinar included information on the structure of the Model, Model details including beneficiary attribution, financial methodology and quality measurement options within the Model, and an explanation of data, learning and evaluation. The state-specific development and application process, including instructions for submitting letters of intent were also discussed. This webinar was open to the general public and targeted towards interested states.
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Similar to Open Door Forum: Comprehensive End Stage Renal Disease Care Initiative - Request For Application (RFA) (20)
The Medicare Advantage Value-Based Insurance Design (VBID) Model team at the Center for Medicare and Medicaid Innovation (CMMI) and national leaders participated in a discussion around pathways for addressing food and nutritional insecurity at webinar event of our Health Equity Incubation Program on Thursday, March 31, 2022, from 3:00-4:30 PM ET.
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The CMS Innovation Center hosted an office hours session on Tuesday, April 5, 2022 from 3:00-4:00 PM ET to discuss the Medicare Advantage Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component. Attendees received an overview of the Model and the CY 2023 application process, and had an opportunity for questions and answers with the Model team.
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The ACO REACH Model Team will hosted a health equity webinar on Tuesday, April 5, 2022 from 4:00 - 5:00 p.m. EDT. The ACO REACH Model team highlighted Health Equity provisions added to the ACO REACH Model.
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This webinar focuses on the new financial policies featured in the ACO REACH webinar. For more information on the financial methodology for the ACO REACH Model that will be transitioned from the Global and Professional Direct Contracting (GPDC) Model, please refer to prior released financial webinars available on the GPDC Model webpage.
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The CMS Innovation Center will host a webinar on Thursday, March 10, 2022 from 3:00-4:00 PM ET. During this webinar, presenters will provide a brief review of the recently released Calendar Year (CY) 2023 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component as well as the payment design related to the Hospice Benefit Component of the VBID Model. This session will also offer attendees an opportunity to ask follow-up questions.
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This webinar provided an overview of the Model and the Part D Sponsor application process, as well as included a Q&A session for interested Part D sponsors.
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The CMS Innovation Center hosted a webinar on Wednesday, March 2, 2022 at 3pm – 4pm ET, during which presenters shared updates on the Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model, the Kidney Care Choices (KCC) Model, and the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. This event was available to the first 1,000 registrants. Presentation materials will be available on the respective model webpages following the session.
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The Medicare Advantage Value-Based Insurance Design (VBID) Model Team hosted an office hours session on Thursday February 3rd, 2022 on the Hospice Benefit Component to provide technical and operational support to interested stakeholders. During this office hours session, presenters answered questions submitted in advance to the VBID Mailbox and offered attendees an opportunity to ask additional questions.
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Has your organization prioritized addressing health inequities? How can a Center for Medicare and Medicaid Innovation (CMMI) Model factor into your organization’s health equity strategy? How can you structure your plan’s benefits to have the greatest impact on underserved communities? What partnership opportunities are available with CMMI?
These are important questions CMMI plans to answer in a new webinar series focused on health equity! CMMI is sponsoring a series of webinars for current and potential Medicare Advantage Organization (MAO) participants in the Value-Based Insurance Design (VBID) Model.
The first webinar in the series provided an overview of the Model’s Health Equity Incubation Sessions effort, articulated a business case for MAOs to leverage VBID Model Components to address health inequities in their member populations, and provided specific guidance and clarification on the full extent of health equity focused flexibilities that fall under the Model’s waiver authority.
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The ET3 Model and Medicaid: Opportunities for Alignment webinar provided background on the ET3 Model, discussed the benefits for states of aligning coverage and payment policies with ET3, and explored considerations for states seeking to implement new Medicaid services that align with the ET3 Model. This webinar was intended for state Medicaid agencies, ET3 Model Participants, and other stakeholders interested in learning more about optional Medicaid alignment with the ET3 Model.
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CMS announced an Office Hour event for potential applicants to ask questions ahead of the PCF application deadline.
The PCF Model Team was available to answer questions on key topics including eligibility, payment design and attribution, and more.
You may also refer to the materials from the two PCF webinars held in March: Introduction to PCF and Ready, Set, Apply.
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In order to help ETC Model Participants prepare for the ETC Model, CMS conducted an introductory webinar on Wednesday, December 9, 2020 from 1 p.m. to 2 p.m. The webinar provided an overview of the ETC Model, including:
Participant selection
The Home Dialysis Payment Adjustment
The Performance Payment Adjustment
The ETC Model timeline, including the timing of payment adjustments
Information about how to communicate with CMS about the ETC Model
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The Value-Based Insurance Design (VBID) Model team hosted a webinar on January 28, 2021 from 4:00-5:00 PM EST. During this webinar, presenters provided a brief review of the recently released Calendar Year (CY) 2022 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component. This session also offered attendees an opportunity to ask follow-up questions.
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The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Wednesday, March 17, 2021 from 4:00 - 5:00 PM EDT. During this webinar, presenters provided a preview of the Calendar Year 2022 payment design related to the Hospice Benefit Component of the VBID Model. The session also offered attendees an opportunity to ask follow-up questions.
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The Part D Senior Savings Model and Part D Payment Modernization Model teams hosted a webinar on Tuesday, March 23, 2021 from 1:00 to 2:00 PM EDT. During this webinar, presenters provided an overview of the two Models and the Calendar Year (CY) 2022 application process. The session also offered attendees an opportunity to ask follow-up questions.
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CMS hosted a virtual office hour session on April 13, 2021 from 4:00-5:00 PM EDT. During this office hour, presenters provided a review of the Calendar Year 2022 payment design and payment rates related to the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model. This session also offered attendees an opportunity to ask follow-up questions.
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CMS Innovation Center
http://innovation.cms.gov
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The Emergency Triage, Treat, and Transport (ET3) Model Medical Triage Line Notice of Funding Opportunity (NOFO) webinar provided an overview of the application process and NOFO requirements for implementing 911 medical triage lines. This webinar was intended for those interested in learning more about the ET3 Model’s Notice of Funding Opportunity, which was released March 12.
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The Primary Care First Model (PCF) Options team provided an overview of the PCF payer partnership. Participants were able to learn about current PCF Model participants, benefits to payer partnership, the framework against which payer proposal alignment will be evaluated, and the payer solicitation process and timeline.
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The Primary Care First Model Options team provided an overview of the Model, including goals, eligibility to participate in the second cohort, payment design and attribution, and data sharing. Model staff answered your questions about these topics.
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The Community Health Access and Rural Transformation (CHART) Model team hosted an overview webinar on Tuesday, August 18, 2020 from 1:00 - 2:30 PM EDT. Attendees had the opportunity to hear an overview of the CHART Model, including its objectives, eligible participants and their roles, payment options, and timeline.
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Open Door Forum: Comprehensive End Stage Renal Disease Care Initiative - Request For Application (RFA)
1. The Comprehensive ESRD Care (CEC) Model
Open Door Forum
April 24, 2014
Alefiyah Mesiwala, MD MPH
Lead, Comprehensive ESRD Care
CMS Innovation Center, CMS
2. 2
Introduction
• The purpose of this initiative—the Comprehensive ESRD
Care (CEC) Model—is to create financial incentives for
dialysis facilities, nephrologists, and other Medicare
providers of services and suppliers to comprehensively
improve beneficiary outcomes and reduce per capita
expenditures.
• Beneficiaries with end-stage renal disease (ESRD) are
among the most medically fragile and high cost populations
served by the Medicare program.
• CMS expects approximately 20,000 beneficiaries will match
to 10 to 15 unique ESRD seamless care organizations
(ESCOs) during the test of the Model
http://innovation.cms.gov/initiatives/comprehensive-ESRD-care
3. 3
RFA Changes
• This presentation incorporates the changes in
the RFA updated April 15, 2014.
• It also includes information, much of which
was incorporated into the RFA, from the
Frequently Asked Questions (FAQ’s) document
April 15, 2014.
4. 4
Policy Revisions
The revisions reflecting revised policy for the CEC
initiative are as follows:
– Removal of the requirement for an independent
nephrologist and/or nephrology practice to be a
participant owner of the ESCO entity. A nephrologist
and/or nephrology practice are still required participants
of the ESCO.
– Revisions to the financial risk arrangements to increase the
financial incentive for both large dialysis organization
(LDO) and non-LDO applicants to reduce costs to
Medicare.
– Additional option for non-LDO aggregation for the
purposes of financial calculations. Aggregation will allow
for non-LDO applicants to pool together to collectively
increase the number of matched beneficiaries.
5. 5
Application Process Change
• Letters of Intent are due on June 23, 2014 for
LDO applicants and September 15, 2014 for
non-LDO applicants.
– Applicants will be unable to access the application page without
first submitting an LOI.
• Applications are due on June 23, 2014 for LDO
applicants and September 15, 2014 for non-LDO
applicants.
• Questions about the Letter of Intent should be
directed to: ESRD-CMMI@cms.hhs.gov
6. 6
Model Background
• Establishes a new Medicare model of
payment to test for
– improving care for beneficiaries with ESRD
– reducing costs to the Medicare program
• Developed under the authority of the Center
for Medicare and Medicaid Innovation
(CMMI)
– Section 3021 of the Affordable Care Act
7. 7
Model Description
• Hypothesis: comprehensive medical management
of, and better care coordination for, ESRD
beneficiaries will result in improved outcomes and
expenditure savings
– Comprehensive and Coordinated Care Delivery
– Enhanced Patient-Centered Care and Improved
Communication
– Improved Access to Services
8. 8
What is an ESCO?
• Group of healthcare providers and suppliers who will work
together to provide beneficiaries with a more patient-centered,
coordinated care experience.
• The ESCO and its participants agree to become accountable for
the quality, cost and overall care of matched beneficiaries and to
comply with the terms and conditions of the ESCO Model
Participation Agreement.
– Participants include participant owners and participant non-
owners
9. 9
What is an ESCO? (cont’d)
• Must have a taxpayer identification number (TIN)
• Separate and unique legal entity
• Recognized and authorized to conduct business
• Must be capable of:
– Receiving and distributing shared savings payments;
– Repaying shared losses, if applicable; and,
– Establishing reporting mechanisms and ensuring ESCO
participant compliance with program requirements,
including but not limited to quality performance
standards
10. 10
What is an ESCO? (cont’d)
• Legal entity recognized and authorized under applicable State, Federal, or Tribal law
and identified by a Tax Identification Number (TIN);
• Each ESCO must have at least one of each of the following included as participant
owners:
– A dialysis facility; and
– A nephrologist and/or nephrology practice.
• This may also include eligible Medicare-enrolled provider or supplier including
physicians and non-physician practitioners, but excluding Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers, ambulance suppliers, and
drug/device manufacturers.
• CMS no longer requires that at least one nephrologist and/or nephrology practice be
an independent entity.
11. 11
What is an ESCO provider/supplier?
• An individual or entity that
– is a Medicare-enrolled provider or supplier other than a DMEPOS supplier,
ambulance suppliers and drug or device manufacturers,
– is identified by an or National Provider Identifier (NPI) or CMS Certification
Number (CCN); and,
– bills for items and services it furnishes to Medicare fee-for-service beneficiaries
under a Medicare billing number assigned to a TIN of an ESCO participant.
• All ESCO providers/suppliers
– must be included on the ESCO’s TIN/NPI list submitted to CMS on an annual basis
and
– Are required to comply with applicable terms and conditions of the CEC Model
Participation Agreement.
12. 12
What is an ESCO participant-owner?
• A Medicare-enrolled entity that:
– is comprised of one or more ESCO providers/suppliers, each of whom bills
under the same Medicare-enrolled TIN assigned to the entity,
– has an ownership stake in the ESCO,
– is a signatory to the ESCO Model Participation Agreement, and
– assumes a minimum portion of the liability for shared losses (“downside
risk”) as specified by CMS and agrees CMS may recover such shared
losses.
• All dialysis facilities and nephrologists/ nephrologist group practices
participating in the ESCO must be participant-owners.
14. 14
Applicant Eligibility
• Together, the following providers are eligible to form an ESCO that
may apply to participate in the Model:
– Medicare Certified dialysis facilities, including
• facilities owned by large dialysis organizations (LDOs),
• facilities owned by small dialysis organizations (SDOs),
– SDOs also referred to as non-LDOs
• hospital-based facilities, and
• independently-owned dialysis facilities;
– Nephrologists and/or nephrology practices; and
– Certain other Medicare enrolled providers and suppliers
15. 15
Applicant Eligibility
• The same ESCO may not include dialysis
facilities owned by different LDOs.
• Dialysis facilities owned by LDOs cannot
partner with dialysis facilities owned by non-
LDOs.
– There are no limitations on partnerships among
non-LDO organizations/facilities in the submission
of a single ESCO application
16. 16
Applicant Eligibility
• Must have a minimum of 350 ESRD beneficiaries matched to ESCO
– Non-LDO ESCOs will be offered the opportunity to aggregate the beneficiaries
it serves with those served by other non-LDO ESCOs to form an “aggregation
pool”
• Organizations will not be able to submit a single application for multiple facilities
located across different markets
– Markets are defined as no more than two contiguous Medicare core-based
statistical areas (CBSA) with permissible inclusion of contiguous rural counties
that are not included in a Medicare CBSA.
• Exception: For rural applicants not included in any Medicare CBSA, the
market area of the ESCO will be defined based on a geographic unit no
larger than a state.
17. 17
Applicant Eligibility
Question: If I am already participating in another
Shared Savings Program, am I eligible to participate in
this initiative?
Answer: The Taxpayer Identification Numbers (TIN) of
ACO participants and the TINs through which ACO
providers/suppliers bill in the Medicare Shared Savings
Program are NOT eligible.
Individual providers/suppliers participating in other
shared savings programs, with the exception of primary
care providers participating in the Pioneer ACO model,
are eligible.
18. 18
Applicant Eligibility
• Individual ESCO applicants in a given non-LDO
aggregation pool will remain independent legal entities
and be treated as such for purposes of meeting all other
program requirements
• Non-LDO applicants that have preferences regarding
which other organizations will be aggregated with for
purposes of financial calculations should provide that
information to ESRD-CMMI@CMS.hhs.gov before the
close of the application period
19. 19
Other Provider Types
Question: Other than dialysis facilities and
nephrologists or nephrology practices, are ESCOs
required to include other particular types of
providers or suppliers?
Answer: CMS does not have requirements for how
many other providers or supplies should participate
in the ESCO.
20. 20
ESCO Beneficiary Matching
• CMS will match beneficiaries to an ESCO based on dialysis
utilization using a “first touch” approach—meaning that a
beneficiary’s first visit to a given dialysis facility during a
particular period will prospectively match that beneficiary to
the dialysis facility, and by extension the ESCO, for the
upcoming performance year.
• Historical matching is based on “first touch” using historical
claims data for a prescribed look-back period
• Quarterly matching
21. 21
ESCO Beneficiary Matching
To be matched to an ESCO, a beneficiary:
• Must be enrolled in Medicare parts A and B
• Must be receiving dialysis services
• Must reside in the United States and within the market area of the
ESCO and receive at least 50% of his/her annual dialysis services
(measured by expenditures) in the ESCO’s geographic area
• Must be age 18 years of age or older
– Pediatric beneficiaries (age 17 and younger) are excluded from
matching due to different needs of this small population (<1% of total
ESRD beneficiaries).
22. 22
ESCO Beneficiary Matching (Cont’d)
To be matched to an ESCO, a beneficiary:
• Must NOT have already been assigned or aligned to a Medicare ACO or another
Medicare program/demonstration/model involving shared savings at the date
of initial matching for the ESCO Model
• Must NOT have a functioning transplant
• Must NOT have Medicare as a secondary payer
• Must NOT be enrolled in a Medicare Advantage plan, cost plan, or other non-
Medicare Advantage Medicare managed care plan
23. 23
Non-LDO Aggregation
Question: What is non-LDO Aggregation and why is it
important?
Answer: Non-LDO aggregation allows non-LDO ESCOs to
more easily satisfy the requirement that an ESCO have a
minimum of 350 matched beneficiaries for financial
purposes. CMS will offer each non-LDO ESCO applicant
an opportunity to aggregate the beneficiaries it serves
with those served by other non-LDO ESCOs. Non-LDO
ESCOs that aggregate matched beneficiaries with one
another form an “aggregation pool.”
24. 24
Non-LDO Aggregation (Con’t)
Question: Who is eligible to participate in non-LDO
Aggregation?
Answer: Only non-LDO applicants are eligible to
select aggregation. This includes both non-LDO
applicants that can meet the minimum threshold for
matched beneficiaries as well as those ESCOs who
are unable to meet the requirement.
25. 25
Determination of Aggregation Pools
Question: How will CMS determine aggregation pools?
Answer: CMS will take into account the applicant’s preferences for
aggregation partners when making final decisions.
– CMS will provide information on the matched population size, location, and
organizational composition of all non-LDO finalists.
– All non-LDO finalists will be given the option to enter the model through a
default aggregation pool that includes all non-LDO finalists.
– CMS will also consider requests by multiple subsets of such finalists to form
a smaller aggregation pool as long as that smaller pool would still meet the
350 beneficiary minimum.
26. 26
Clarification
• The Innovation Center has closely worked with other
CMS components and stakeholders to revise the CEC
model to allow for broad participation by both large
dialysis organizations (LDOs) and non-LDOs.
• The new policy of non-LDO aggregation will ensure
non-LDO participation by allowing non-LDOs that
cannot individually meet beneficiary minimums to
collectively meet the minimum for financial purposes.
• It will also allow all non-LDOs the opportunity to
collectively lower minimum savings rate and increase
financial incentives under the Model.
27. 27
Payment Arrangements
• The payment arrangements included in the CEC Model
are directly tied to the organizational size of the
applicant—namely whether or not the applicant ESCO
includes an LDO facility. (Risk-based)
• The payment arrangements are non-negotiable.
• All applicants that include an LDO facility will be in the
two-sided payment track.
• Applicants that include only non-LDO facilities will be in
the one-sided payment track.
28. 28
Payment Arrangement (cont’d)
• For all ESCOs that enter agreements to continue
participation in the model for years 4 and 5, the
benchmark would not be rebased
• LDO ESCOs will have benchmarks reduced to reflect a
discount applied only to all non-dialysis Fee-for-
Service Medicare Part A and Part B costs from year 3
forward.
29. 29
LDO 2-Sided Risk Track
Question: In the revised RFA published on April 15,
2014, what are the changes to the LDO 2-sided risk
track?
Answer: In the LDO 2-sided risk track, CMS has
eliminated rebasing in performance years 4 and 5. In
addition, CMS will only apply the guaranteed discount to
the non-dialysis FFS Part A and B per capita benchmark
starting in year 2 at 1%, year 3 at 2%, year 4 and
onwards at 3%.
30. 30
Non-LDO Risk Track
Question: In the revised RFA published on April 15,
2014, what are the changes to the non-LDO risk track?
Answer: CMS no longer is offering two risk track
options for non-LDOs. The revised RFA describes the
one-sided risk track now being offered for non-LDO
ESCOs. The shared savings percentage between CMS
and the ESCO will be 50% in performance years 1
through 5. Like the LDO risk option, CMS has eliminated
rebasing in performance years 4 and 5.
31. 31
Payment Arrangement (cont’d)
Design Feature LDO ESCO
2-Sided Risk
Non-LDO ESCO
1-Sided Risk
Risk Structure 2-sided 1-sided
Minimum savings rate
(MSR)
+/-1% threshold for first-
dollar shared savings or
losses (option for higher
threshold if desired)
4.75% MSR for first-dollar
shared savings at 350
beneficiaries, decreasing to
2% as number of
beneficiaries increase to
2,000
32. 32
Payment Arrangement (cont’d)
Design Feature LDO ESCO
2-Sided Risk
Non-LDO ESCO
1-Sided Risk
Guaranteed Discount Guaranteed discount
applied only to non-
dialysis FFS Part A and B
per capita benchmark
Year 1: 0%
Year 2: 1%
Year 3+: 2%
Year 4+: 3%
None
Shared Savings / Shared
Loss Percentages
After locking in
guaranteed discounts,
sharing up to 70% of
first-dollar
savings/losses in year 1,
75% in years 2+
50% in years 1-3, 3+
33. 33
Payment Arrangement (cont’d)
Design Feature LDO ESCO
2-Sided Risk
Non-LDO ESCO
1-Sided Risk
Caps on Shared
Savings/Shared Losses
10% years 1&2
15% years 3+
5% in years 1-3, 3+
Rebasing No rebasing No rebasing
35. 35
Length of Agreement
• Agreements will have an initial term consisting of
three performance periods with an option to
extend for two additional 12-month performance
periods.
– First performance period expected to begin in January
2015 for LDO applicants and July 2015 for non-LDO
applicants
• Additional performance periods may be offered in
part to the ESCO meeting financial and quality
performance targets.
36. 36
Length of Agreement (cont’d)
• CMS may choose not to offer the additional two
performance periods if:
– The ESCO does not generate savings and/or
– Meet performance standards or other performance
requirements during the first two performance periods.
• CMS may terminate the agreement at any point due
to non-compliance with the CEC Model
Participation Agreement and/or performance
related issues.
37. 37
Agreement Withdrawal
• Applicants seeking to withdraw or amend their applications
must submit an electronic withdrawal request to CMS via the
following mailbox: ESRD-CMMI@cms.hhs.gov. The request
must be submitted as a PDF on the organization’s letterhead
and signed by an authorized corporate official, and include:
• the applicant organization’s legal name; organization’s primary
point of contact; full and correct address of the organization; and, if
applicable, the specific CMS Certification Numbers (CCNs) and/or
National Provider Identifier (NPI) numbers it seeks to remove from
a pending application.
38. 38
Governance & Leadership
• ESCO must maintain an identifiable governing
body
• Must have:
– Authority to execute the functions of the ESCO
– Authority for final decision-making for the ESCO
– A conflict of interest policy
– A transparent governing process to ensure CMS has
the ability to monitor and audit as appropriate.
39. 39
Governance & Leadership (cont’d)
• ESCO participants (owners and non-owners) must have at
least 75% control of the ESCO’s governing body.
• No one participant in the ESCO can represent more than 50%
of the membership on the governing body.
• Members must place their fiduciary duty to the ESCO before
the interests of any ESCO participant.
• The governing body must include an independent ESRD
Medicare beneficiary representative and a trained and/or
experienced non-affiliated, independent consumer advocate
on the governing body.
40. 40
Quality Performance
Question: What is the set of quality measures that will
be used for assessing ESCO quality performance?
Answer: CMS will require the assessment of claims-
based and clinical quality measures as well as
administration of surveys as outlined in the CEC Model
RFA for assessing ESCO quality performance.
• CMS and/or its contractor intends to provide a draft set of
quality measures to potential ESCOs that apply to participate in
the CEC model. CMS will provide a final set of quality measures
for review to selected participants prior to requiring
participants to sign the CEC Model Participation Agreement.
41. 41
Quality Performance (cont’d)
• ESCOs will be required to meet a minimum threshold
score in order to be eligible for shared savings.
• The quality measure domains are:
– Preventive health
– Chronic disease management
– Care Coordination/Patient Safety
– Patient/Caregiver Experience
– Patient Quality of Life
42. 42
Data Sharing
• CMS plans to share several types of Medicare
data with ESCOs to support care improvement
efforts
• Beneficiaries will have 30 days to opt out of
having their identifiable data shared with the
ESCO before CMS begins sharing data.
– Beneficiaries may opt out of data sharing at any
time thereafter.
43. 43
Data Sharing (cont’d)
• CMS plans to share the following data files and reports
with ESCOs on a regular basis:
– At the start of the first performance year – Detailed, standard (not
customized), historical (one year) claims data on matched beneficiaries
who have not opted out of data sharing. During each performance year,
CMS will also provide historical claims data as additional beneficiaries
are matched to the ESCO.
– On a monthly basis – Standard beneficiary-level claims feeds, which will
include beneficiary identifiers, and services delivered by providers inside
and outside of the ESCO.
44. 44
Data Sharing (cont’d)
• CMS plans to share the following data files and reports
with ESCOs on a regular basis:
– On a monthly basis – Total Medicare Part A and B
expenditures and claims lag reports.
– On an annual basis – Financial reconciliation reports,
including the ESCO’s performance on quality and patient
experience metrics.
45. 45
Public Reporting
• The CEC Model emphasizes transparency and
public accountability.
• At a minimum, ESCOs will be required to publicly
report information regarding their organizational
structure and participants.
• At a minimum, CMS will publicly report the quality
performance scores of participating ESCOs,
including beneficiary experience outcomes.
– Specific public reporting requirements will be clearly
outlined in the CEC Model Participation Agreement.
46. 46
Learning and Diffusion Resources
• The CMS Innovation Center is working with
national healthcare experts to develop resources
and activities to support the CEC Model and its
primary aims.
• The CMS Innovation Center will support ESCOs in
accelerating their progress by providing them
with opportunities to learn how care delivery
organizations can achieve performance
improvements quickly and efficiently, and
opportunities to share their experiences with one
another and with participants in other CMS
Innovation Center initiatives.
47. 47
Learning and Diffusion Resources
(cont’d)
• The CMS Innovation Center will test various
approaches to group learning and exchange,
helping program participants effectively:
– Share their experiences
– Track their progress
– Rapidly adopt new ways of achieving improvements in
quality, efficiency and population health for Medicare,
Medicaid and CHIP beneficiaries.
48. 48
Learning and Diffusion Resources
(cont’d)
• In order to fulfill the terms and conditions of
the Model, all selected ESCOs are expected
to:
– Participate in periodic conference calls and
meetings and
– Actively share resources, tools, and ideas with
each other via an online collaboration site being
developed by the CMS Innovation Center.
49. 49
Final Take-Aways
Letter of Intent
• Must be submitted by June 23, 2014 for LDO applicants and
September 15, 2014 for non-LDO applicants.
• CMS will only consider applications from organizations that
have submitted a letter of intent by the deadline. However,
the letter of intent is non-binding.
– Applicants will be unable to access the application page without first
submitting an LOI.
• Template available in Appendix A of the RFA.
• Online-only submission process.
50. 50
Final Take-Aways (cont’d)
Application
• Must be submitted electronically no later than June 23,
2014 for LDO applicants and September 15, 2014 for non-
LDO applicants.
• Template available in Appendix B.
• Must include 100% of proposed ESCO participant owners