Table Of Content1
2003 Edition
Report
Active Projects
Research and Demonstrations in Health Care Financing
Contents
1 Theme 1: Monitoring and Evaluating CMS Programs
1 Theme 2: Improving Managed Care Payment and Delivery
23 Theme 3: Improving Fee-for-Service Payment and Delivery
47 Theme 4: Future Trends Influencing Our Programs
51 Theme 5: Strengthening Medicaid, State Children's Health Insurance Program (SCHIP),
and State Programs
99 Theme 6: Meeting the Needs ofVulnerable Populations
107 Theme 7: Outcomes, Quality and Performance
123 Theme 8: Building Research Capacity
157 Mandate and Authority
173 Indices:
• TopicalIndex
• AlphabeticalIndex ofResearch andDemonstration Projects
• Awardee Organizations
• PrincipalInvestigators
• State Index ofResearch andDemonstration Projects
• CMSProject Officers andProjectDirectors
&
• FactsAbout the CentersforMedicare MedicaidServices
&
Centers for Medicare Medicaid Services
U.S. Department ofHealth and Human Services
Tommy G. Thompson, Secretary
&
Centers for Medicare Medicaid Services
Thomas A. Scully, Administrator
Leslie V. Norwalk, Acting Deputy Administrator and ChiefOperating Officer
Office ofResearch, Development, and Information
Stuart Guterman, Director
William D. Saunders, Deputy Director
This report was produced by:
Systems, Technical and Analytic Resources Group
Eric Katz, Director
David Gibson, Deputy Director
Production Coordinator
Linda R. Lebovic
ftA
Active Projects Report
Research and Demonstrations in Health Care Financing
2003 Edition
Centers for Medicare & Medicaid Services
.
FOREWORD
The Centers for Medicare & Medicaid Services (CMS) isresponsible foradministeringthe Medicareprogram and
programs administeredby States such as Medicaid andthe State Children's Health Insurance Program (SCHIP). CMS
oversees insurance regulation, the survey and certification ofhealth care facilities, and the Clinical Laboratory
Improvements Amendments. We serve one in fourseniors, children,people withend stage renal disease, andpeople
with disabilities. We also provide beneficiaries with informationaboutourprograms, Medigap options, consumer
research, and grievanceandappeals processes.
CMS directs roughly 600 individual research, demonstration, and evaluationprojects. Ourresearchhelps us to identify
future trends thatmay influence ourprograms, meetthe needs ofvulnerable populations, andexamine the cost
effectiveness ofourpolicies. Demonstrationprojects test, forexample, how anewpayment system, preventive service
orhealthpromotioncampaign actually affects ourprograms, beneficiaries, States, andproviders. Evaluationprojects
validate ourresearch and demonstration findings and helpus monitorthe effectiveness ofMedicare, Medicaid, and
SCHIP.
One ofthe Agency's challenges is to develop and implement newhealthcarepayment approaches andfinancing
policies andto evaluate the impactofourprograms. Anotherishow to modernize Medicare from a medical acute care
model to a comprehensive healthcare modelthat encourages healthy aging. CMS strives to meet the challenges of
short-term health policyneeds witha long-termperspective toprovide meaningful information andanalyses responsive
totheneeds ofourprograms andcustomers. CMS, togetherwith States, contractors, grantees, andotherFederal
agencies, is committedto research anddemonstrations aimedat improving ourprograms, ensuring the quality ofcare
andprovidingmodernhealth care services.
Congress created Medicare and Medicaid in 1965. Medicare originallyprovidedhealthcare coverage to Americans
overthe age of65. In 1972, the programwas expandedto Americans living withdisabilities and people with end stage
renal disease. Medicaidis ajoint Federal-Stateprogramthatprovideshealthcare coveragetotheaged, blind, people
with disabilities, and low-income familieswith childrenunder21
CMS research bothanticipates the future ofourprograms, andreflects the Agency's legislative and operational
responsibilities. More recent legislation includes:
• The Health Insurance Portability andAccountabilityActof1996 (HIPAA) provided forimprovedcontinuityor
"portability" ofgroup health plan coverage and forgroup health insurance providedthrough employment or
through the individual insurance market. CMS regulatesthe small and individual private health insurance markets
andnational administrative simplification standards forall electronic health care transactions.
• The Balanced Budget Act of 1997 (BBA) establishedMedicare+Choice as PartC ofthe Medicareprogram,
creatingan array ofnew managedcare andotherhealth plan choices forbeneficiaries, in addition to a coordinated
open enrollmentprocess.
The BBA also createdthe State Children's Health Insurance Program(SCHIP) which is designedto assistthose
working families with incomestoohigh for Medicaidbuttoo lowto be able to affordprivate health insurance.
The BalancedBudget RefinementAct of1999made numerous changestothe Medicareprogram aimedatreducing
the impact ofthepaymentreductions to providers in the BBA, stabilizedthe SCHIP allotment formula and
modifiedthe Medicaid Disportionate Share Hospital program.
• The Ticket to Work and Work Incentives ImprovementActof1999 expandedthe availabilityofMedicare and
Medicaid forcertain beneficiaries with disabilities who return to work. The New Freedom Initiative announcedby
President Bush on February 1, 2001 ispartofanationwideeffortto remove barriers to community living for
people with disabilities.
• In 2000, the Benefits ImprovementandProtection Actmade numerous changes to the Medicare, Medicaid and
SCHIP programs.
The Office ofResearch, Development, and Information prepares the annualActiveProjectsReport: Researchand
Demonstrations inHealth CareFinancingto informCMS customers ofourresearch. It inventoriesboth intramural
projects conductedby CMS staffandextramuralprojects conductedby contractors, grantees, andotherawardeeswith
CMS support. While most ofthe extramuralprojects are funded from CMS' research, demonstration, and evaluation
budget, some ofthe quality-related studies conductedbyQuality Improvement (formerly PeerReview) Organizations
are supportedbyotherCMS budgets.
The 2003 edition oftheActiveProjectsReportprovidesbasic informationon CMS research, demonstrationand
evaluation projects active fromJanuary 1 through December31, 2002. It is organizedbytheme:
Theme 1 Monitoring and Evaluating CMS Programs;
Theme 2 Improving ManagedCare Paymentand Delivery;
Theme 3 Improving Fee-For-Service Payment and Delivery;
Theme4 Future Trends InfluencingOurPrograms;
Theme 5 Strengthening Medicaid, State Children's Health Insurance Program (SCHIP), and State Programs;
Theme 6 Meetingthe Needs ofVulnerable Populations;
Theme 7 Outcomes, Qualityand Performance; and
Theme 8 Building Research Capacity.
TheActiveProjectsReportpresents abriefdescription ofeach projectand its status as ofDecember31, 2002. The
abstractsprovidean identificationnumber, the projecttitle,the CMS project officername, the awardee, funding, and
theperiod ofperformance. Several indices are providedattheback ofthis book to help readers locate information
regarding specificprojects - organizedbyprojecttitle, project officer, principal investigator, awardee organization,
Stateand legislative mandate summary. More detailedinformation regarding specificprojects may be obtainedfrom
CMS
projectofficers directly.
This is thetwenty-thirdedition ofTheActiveProjectsReport. Formore information, please visitthe CMS website at
www.cms.hhs.gov.
Stuart Guterman
Director
OfficeofResearch, Development, andInformation
OfficeofResearch,Development,andInformation
CENTERS FORMEDICARE & MEDICAIDSERVICES
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Active Projects Report 2003 Edition
Theme Monitoring and
I :
Evaluating CHS Programs
As the United States health care system continues to change, there is an ongoing need to monitor and
evaluate the performance of the programs CMS administers. Beyond traditional measures of performance,
like cost containment, quality, health outcomes, and access to care, we attempt to measure various
beneficiary-focused attributes, such as knowledge of health behaviors. In our monitoring, we track how well
Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP) meet the needs of specific
groups of beneficiaries, including vulnerable populations. Our research also examines more specific policy
issues. For example, as Medicare and Medicaid continue to pursue managed care options, we examine the
cost-effectiveness and qualityofmanaged care, aswell as beneficiary satisfaction. CMS monitors and evaluates
the impact of Medicaid, welfare reform, SCHIP, and our beneficiary information program on beneficiaries.
CMS is committed to evaluating our programs to gain new insights into how they can perform better. These
insights inform our regulatory, administrative, and legislative policymaking.
CMSBeneficiariesandProgramSpending rehabilitationtherapyservices. These policies include
perbeneficiary therapy limits applicable to certain
Beneficiaries- FederalEntitlementOutlays-
79.3Millionor $417.8Billionor outpatient settings, skilled nursing facility prospective
1 in4oftheNation'sPeople in3oftheNation'sHealthDollars payment system, home health agency prospective
paymentsystem, inpatient rehabilitation facility
Medicare
prospective payment system, long term care hospital
pnly
Medicaid
44% prospective paymentsystem, andoutpatient therapy
S158.7JB
38% prospectivepayment system. This project will study
the period 2000-2003, and will study changes in
Medicaid beneficiary access andutilization oftherapy services
Only MedicareSMI Medicare
43% DuallyEligible $108.9B $254.8B across all these settings with special attention to
forMedicare 26% 61% changes inone ormore settings that follow apayment
andMedicaid change in anothersetting.
8%
Source: FY2003President'sBudget. Status: This is a continuation and extension of
previous work, "Medicare Post-Acute Care: Evaluation
ofBBA Payment Policies andRelated Changes"
01-114 Evaluation ofBalanced Budget
Amendment (BBA) Impacts on Medicare (contract 500-96-0006/04), which coveredthe period
1996-1999.
Deliveryand Utilization ofInpatientand
Outpatient Rehabilitation TherapyServices
ProjectOfficer: PhilipCotterill 02-079 Design and Implementation ofa
Period: September200 -December Targeted BeneficiarySurveyonAccess to
2004 1 Physician Services Among Medicare
Awardee: Health Economics Research Beneficiaries
Funding: $998,540 ProjectOfficer: Renee Mentnech
Period: September2002-September
Description: This project studies the impact ofthe 2003
Balanced Budget Act of 1997 (BBA) on the delivery Awardee: Mathematica Policy Research
and utilization ofinpatient and outpatient rehabilitation (DC)
therapy services to Medicarebeneficiaries. Manyofthe Funding: $0
BBA changes, some already implemented and others
still underdevelopment, directly affectpayment for
Theme Monitoring and Evaluating CMS Programs
I:
y-
,
—
Active Projects Report 2003 Edition
Description:Thepurpose ofthisproject is to design
01-116 Evaluation ofthe Impact on Beneficiaries
andimplement atargeted, short, beneficiary surveyon
ofthe Medicare+Choice Lock-in Provision
access tophysician services among Medicare
beneficiaries. The intent ofthis targeted survey is to ProjectOfficer: Mary Kapp
enhancethe ability ofCMSto determine, on as close to Period: September200l-September
areal time basis as possible, whetherMedicare 2004
beneficiaries are experiencing access problems in Awardee: Barents Group
specific geographic areas. Funding: $380,298
Description:This project will explore the impact on
1-144 Evaluation ofPrivate Fee-for-Service Medicare beneficiaries ofthe lock-inprovision ofthe
Plans in the Medicare+Choice Program
BalancedBudgetActof1997 (BBA). The lock-in
ProjectOfficer: Nancy Zhang provision places limits onthe frequency, timing and
Period: September2001-September circumstancesunderwhichMedicare+Choice (M+C)
2004 enrollmentelections canbemade. These changesare
Awardee: AbtAssociates phasedinovera 2-yearperiodbeginningJanuary 1
Funding: $1,407,867 2002. Thepurpose ofthisprojectisto: 1) examinethe
current (pre-lock-in) patterns ofenrollment and
M+C CMS
Description: The purpose ofthis project isto evaluate disenrollment in using existing
thenewprivate fee-for-service (PFFS) optionavailable administrative data; 2) design amethodologyto
underthe Medicare+Choice (M+C)program. The quantifythe impact on Medicare beneficiaries ofthe
evaluation will use a combination ofprimary and lock-inprovision; and 3) analyze the impacton
secondary data sourcesto evaluate the effects ofthe beneficiaries ofthe first yearofthe lock-inprovision.
option onbeneficiaries andprogramcosts. Primary
datawill be collected through site visits to participating Status: Theproject is in its developmental stage.
plans andbeneficiary surveys. The PFFS plan option
is one ofthenewtypes oforganizationsprovided for
underthe M+C provisions. Theproject involvesthe 00-052 Evaluation ofthe Qualified Medicare
Beneficiary (QMB) and the Specified Low-
Sterling Plan, whichhas been available tobeneficiaries
Income Medicare Beneficiary (SLMB)
since July, 2000 andcapturesmanybeneficiaries who
werepreviously enrolled in an M+C planthatwithdrew Programs
fromthe program andforwhomthis plan isthe only ProjectOfficer: Noemi Rudolph
M+C optionavailable. Analytic issuestobe addressed Period: September 999-November
1
inthe evaluation can be grouped into threebroad 2002
categories: 1) beneficiary analyses (enrollment, Awardee: Health Economics Research
beneficiary experiences withthe plan, utilization); Funding: $1,466,933
2) Medicareprogram impacts (payment); and3)plan
andproviderimpacts (market, program administration, Description: This project is designedto evaluate
participation). quantitatively andqualitativelythe Qualified Medicare
Beneficiary (QMB) andthe Specified Low-Income
Status: This newly initiatedproject is inthe startup Medicare Beneficiary (SLMB) Programs inthe
phase. following areas: 1) the motivations andperceptions of
enrollees andnonenrollees, 2) reasons for State
variation inenrollmentpatterns, 3) the impact of
enrollmenton Medicare and Medicaidcosts and
serviceuse, and4)the impactofenrollmentonout-of-
pocketcosts ofeligible individuals. Primary data
collection activities will include: a survey ofanational
sample ofQMB and SLMB enrollees andofeligible
CMFS> Theme Monitoringand Evaluating CMS Programs
I:
y-
