CMS Medical Home Project Still Lacks Final Approval

CMS still has not received final approval to conduct a medical home demonstration project within the Medicare program, which means the project will not be fully under way for at least another year, according to Jim Coan, the CMS project officer in charge of the demonstration project.

"We are just in a holding pattern," said Coan. "My feeling is eventually we will have a demonstration in the field, hopefully soon, but I can't say when."

Congress created the three-year medical home demonstration project (3-page PDF; About PDFs) as part of the Tax Relief and Health Care Act of 2006. According to the provisions of that act, the project will take place in eight states; CMS will announce the names of the states when the project receives final clearance.

The design of the demonstration will involve up to 400 practices, 2,000 physicians and 400,000 Medicare beneficiaries, according to CMS. Officials expected to launch the project in early 2010, but there have been delays in obtaining final clearance that have pushed the timetable back.

Even if the project were approved tomorrow, it still would take about a year to become fully functional, said Coan. "If you add up all the time -- from the announcement of the project to the recruitment to the application to the qualification process -- it is approximately 12 months," he noted, acknowledging that "everyone is anxious to begin."

"We have been at this for two years, and a lot of work has gone into this from behind the scenes from a lot of different people," said Coan. "I feel their pain … they would have liked to have been underway by now."

If the demonstration project is approved, CMS will invite primary care practices in the eight chosen states to apply to participate. The agency then will decide on final participants and will ask those practices to obtain recognition as patient-centered medical homes through the National Committee for Quality Assurance, Coan said.

"This is a research project, so we want to get some geographic distribution," he added. "We mostly want to get a spread of practices -- the small, medium and large ones, urban and rural, because we want to get findings from this. It is not necessarily going to be done on a first-come, first-served basis."

In the House, meanwhile, the three committees responsible for health care reform legislation have approved a so-called tri-committee bill that would greatly expand the Medicare demonstration project. Coan stressed, however, that, at this time, CMS only has the authority to abide by the provisions set forth in the Tax Relief and Health Care Act of 2006.