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These R&D efforts are intended to provide information needed for modernization of our programs, including Medicare reform efforts in both managed care and fee-for-service, and Medicaid reforms that increase State flexibility in providing coverage to the uninsured and ongoing efforts to improve services provided to the disabled. Our R&D under this theme also supports monitoring and evaluation activities to track how well Medicare meets the needs of specific groups of beneficiaries, including vulnerable populations and to examine specific policy issues within CMS's programs. For example, as Medicare pursues new managed care options, beneficiary satisfaction, quality of care, and cost-effectiveness of these new approaches must be assessed.

PROGRAM MANAGEMENT

New Freedom Initiative- $3 million

In support of the New Freedom Initiative, CMS will continue a national demonstration designed to address workforce shortages of community service direct care workers. The demonstration will test the extent to which workforce shortages and instability might be addressed through better coordination with Temporary Assistance for Needy Families and the availability of vouchers for worker health insurance or for tuition/day care credits. Participating States would be expected to develop options for workers to purchase affordable group health coverage through the State health insurance system or similar organized insurance group.

Real Choice System Change Grants - $40 million

The Budget proposes to continue funding for Real Choice System Change Grants. The grants are intended to assist States to design and implement enduring improvements to community based support systems that enable people with disabilities and long-term illnesses to live and participate in community life. These systematic changes will be designed to enable children and adults of any age with a disability or long term illness to (1) live in the most integrated community setting, (2) exercise meaningful choices about their living environment, and (3) obtain quality services in a manner as consistent as possible with community living preferences and priorities. In FY 2002, a total of $40.0 million funded 25 new Real Choice Systems Change Grants and 5 supplemental Real Choice System Change Grants.

Theme VI. Helping the Uninsured and Increasing Access to Health Insurance

CMS will continue evaluations of SCHIP, Medicaid, and demonstrations mandated by the Ticket to Work and Work Incentives and Improvement Act of 1999. The Ticket to Work statute requires a report to Congress on the impact of the Medicaid buy-in programs and the utilization of the Medicaid Infrastructure Grants. In FY 2004, the RD&E budget will support efforts to gather and analyze the outcomes and lessons learned from the Medicaid buy-in programs. Currently, 17 States are operating Medicaid buy-in programs and 38 States are receiving grant funds for these efforts.

Theme IX. Understanding Health Differences and Disparities

Research is needed to identify existing initiatives that have helped reduce disparities and develop intervention strategies designed to eliminate disparities that impact the health status among women, racial, ethnic, and other vulnerable populations (e.g., African-Americans, Hispanics, Asians and Pacific Islanders, and American Indians/Alaska Natives). Examples of areas of intervention include: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV/AIDS, and child and adult immunization. Current research is being designed to improve understanding of the impact of these utilization differences on the health of the population.

PROGRAM MANAGEMENT

Theme X. Preventing Disease, Illness, and Injury

Several new payment and service delivery models have been identified as important components of a modernized Medicare program including care coordination and disease management services. These components will be explored through a combination of testing new fee-for-service care management approaches for selected populations with conditions such as diabetes, coronary disease, and congestive heart failure.

Theme XI. Agency Specific Priorities

CMS's research budget supports a variety of activities to increase the efficiency of our research and demonstration program and meet the cross-cutting research needs of CMS and the wider health research community. CMS's RD&E budget also supports funding for the Medicare Current Beneficiary Survey (MCBS). MCBS is the only comprehensive source of information on the health status, health care use and expenditures, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries. MCBS is a powerful tool for evaluating our programs, as well as a key source of data for policy research on the Medicare population.

MANDATED RESEARCH INITIATIVES

The Balanced Budget Act of 1997 (BBA), the Balanced Budget Refinement Act of 1999 (BBRA) and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) mandate many demonstrations and evaluations, studies, reports to Congress, and the implementation of several prospective payment systems. The RD&E budget will support our continuing efforts to implement the remaining provisions of BBA, BBRA, and BIPA. The following table displays specific needs for BBA, BBRA, and BIPA:

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APPROPRIATION HISTORY:

PROGRAM MANAGEMENT

The table below displays Research funding for the past 5 years.

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PROGRAM MANAGEMENT

CMS Revitalization Plan

Budget Estimates

As described in the Executive Summary portion of this document, CMS is requesting a new, multi-year investment fund, beginning with $65 million in two-year money to be appropriated in FY 2004. In the first year, the CMS revitalization plan will focus on systems-related activities.

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CMS's systems infrastructure was not designed to keep pace with recent changes in the program or to handle today's massive claims volume, much less the increase in claims volume that will come as today's "baby boomers" become eligible for Medicare. Over the past few years, CMS has taken steps toward revitalizing its operations, such as reducing the number of standard fee-for-service claims processing systems. However, a significant investment is needed if CMS and its partners are to continue to meet the demands of the Medicare program and provide quality service to its beneficiaries.

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