Medical Home Demonstration Implementation

CMS plans to conduct a Medical Home Demonstration as directed by Section 204 of the Tax Relief and Health Care Act of 2006 (TRHCA). The Act calls for the project to provide targeted, accessible, continuous, and coordinated family-centered care to high-need populations through a Medical Home demonstration. The Act also specifies that the demonstration will include Medicare beneficiaries who are deemed to be "high-need" (that is, with multiple chronic or prolonged illnesses that require regular medical monitoring, advising or treatment.) The Medical Home Demonstration will be conducted in up to 8 states including urban, rural and underserved areas, over a 3-year period. CMS planned to identify the demonstration locales in early 2009. The Implementation Contractor is expected to identify, recruit and register interested physician practices within demonstration locales (not yet determined) to participate in the Medical Home Demonstration, and to enroll beneficiary participants into Medical Homes by collecting beneficiary Agreement/Acceptance forms submitted by Medical Homes. The Implementation Contractor will be responsible for applying risk adjustment methodology to the list of beneficiary participants to determine the appropriate monthly Medical Home fee to be paid. Additionally, the Implementation Contractor will conduct the process to recognize qualified physician practices as Medical Home practices and determine their appropriate Medical Home tier at the beginning of the demonstration and also upon request of a practice seeking to qualify for a higher Medical Home tier. The Implementation Contractor will coordinate with the Medical Home Payment Contractor by transmitting files of recognized Medical Home practices and their tier, transmitting files of personal physicians and the Medical Home they are affiliated with, and transmitting risk adjusted files of beneficiary participants. Recruitment of physician practices is expected to begin in March 2009. Payment of monthly Medical Home fees will begin January, 2010. The Implementation Contractor will monitor participating practices to assure the Medical Home model is being appropriately implemented.