As coalitions around the country move towards completing their application for Community-Based Care Transitions Program (CCTP; Section 3026 of the ACA), many teams will encounter difficulties in completing the proposal (see budget worksheet at: http://www.cms.gov/DemoProjectsEvalRpts/downloads/CCTP_ApplicationBudgetWorksheet.zip). Here are a few concerns and helpful suggestions raised during a recent meeting with potential 3026 applicants (from the IHI Triple Aim and ONC Beacon participants).
Regarding finance, the pricing is done on a per unit basis rather than a grant or contract basis that hospitals and community-based organizations (CBOs) might expect. Per unit pricing is just like any other Medicare service. Your program will submit a list of patients served each month and payment will go to the CBO. Some CBOs may find it helpful to confer with someone experienced in per unit pricing (i.e. experience in small business).
You will need to estimate what fixed and variable costs the intervention incurs, along with a reasonable estimation of the number of targeted beneficiaries eligible for your program. Having as precise an estimate as possible of this anticipated volume is crucial in arriving at the correct rate per eligible discharge. Keep in mind that having a lower than anticipated volume can lead to losses (because you incur fixed costs that you did not cover). The greater the volume, the more spread out your costs will be!
One way of improving your volume estimate is getting a good approximation for the acceptance rate into the program, which can be based on previous experience. Many programs initially have very high refusal rates, but usually you can decrease that over time. Although the budget worksheet does not include a place for an acceptance rate, you could modify your entry on Row B and then enter the explanation in an accompanying footnote.
“Not-to-exceed” budget is another aspect that might cause some confusion. Basically, your not-to-exceed budget is the money CMS will set aside for your entire program. Remember that the budget you are proposing is for five years. There might be changes in your program over this time period, only some of which you could predict. For example, you might be able to streamline your intervention over the first two years or you might predict an increase in patient volume. You could write in these predicted changes with a modification on Row M and then enter the explanation in an accompanying footnote. The aim of the program is to be integrated as a permanent part of Medicare, and to this end it allows and encourages learning throughout the program. However, the degree of flexibility is unknown.
Here is the link to the powerpoint presentation from the meeting on 7/12/11: http://medicaring.org/wp-content/uploads/2011/07/CCTP-Budget-Proposal.pptx
This is a collaborative effort and the above suggestions would not have been available if not for care transitions teams sharing their experience. So any comments, questions or modifications to our suggestions are encouraged. Please send your response to firstname.lastname@example.org.
Key words: section 3026 applicants, Affordable Care Act (ACA), medicare, budget worksheet, financing, CCTP, care transitions, patient volume, rate per eligible beneficiary, IHI Triple Aim, ONC Beacon, community-based organizations