Assistance program
Affordable Care Act Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents
$68.7 Million committed in FY2018–FY2022
- Agency
- Centers for Medicare and Medicaid Services, Health and Human Services, Department of
- Assistance
- Project Grants
- CFDA number
- 93.621
- What it does
- Under this Initiative, the Centers for Medicare & Medicaid Services (CMS) selected eligible organizations to test a series of evidence-based clinical interventions. Eligible organizations will partner with long-term care (LTC) facilities and practitioners to implement and test a new payment model with the goal of improving the health and health care among LTC facility residents and ultimately reducing avoidable hospital admissions. The goal of these interventions is to improve the health and health care among long-stay nursing facility residents and ultimately reduce avoidable inpatient hospital admissions. Successful applicants will implement the payment model along with interventions that will have the following objectives (consistent with Phase I): • Reduce the frequency of avoidable hospital admissions and readmissions; • Improve resident health outcomes; • Improve the process of transitioning between inpatient hospitals and nursing facilities; and • Reduce overall health care spending without restricting access to care or choice of providers.
- Who benefits
- The primary target population for the clinical interventions is fee-for-service Medicare-Medicaid enrollees in nursing facilities, but fee-for-service long-stay residents who are not yet Medicare-Medicaid enrollees will also benefit (i.e., Medicare beneficiaries not yet eligible for Medicaid, or Medicaid beneficiaries not yet eligible for Medicare but who represent similar opportunities for inpatient reductions).
- Who applies
- Applicants eligible to be enhanced care & coordination providers included, but were not limited to: • Organizations that provide care coordination, case management, or related services; • Medical care providers, such as physician practices; • Health plans (although this initiative will not be capitated managed care); • Public or not-for-profit organizations, such as Aging and Disability Resource Centers, Area Agencies on Aging, Behavioral Health Organizations, Centers for Independent Living, universities, or others; • Integrated delivery networks, if they will extend their networks to include unaffiliated nursing facilities. Nursing facilities, entities controlled by nursing facilities, or entities for which the primary line of business is the delivery of nursing facility/skilled nursing facility services were excluded from serving as enhanced care & coordination providers under this cooperative agreement. Legal Status: To be eligible, an organization must have been recognized as a single legal entity by the State where it is incorporated, and must have had a unique Tax Identification Number (TIN) designated to receive payment. The organization must have had a governing body capable of entering into a cooperative agreement with CMS on behalf of its members.
- Authorized by
- Affordable Care Act, Public Law 111-148, section 3021.
Committed by fiscal year
Top recipients
By dollars committed.
How to read these numbers
- Committed through this program
Money committed under this assistance listing (its CFDA program), counted in the year each action happened.
- How it's paid
Most programs pay out one way — a grant, or a direct payment to individuals; the flow bar only appears when a program genuinely mixes types.
- Some recipients aren't itemized
For entitlement programs like Social Security and Medicare, the government reports one aggregate instead of naming tens of millions of people, so the recipient roster isn't part of the public record.
- Awards, counted once
An award count is the number of distinct awards with at least one action that year — each counted once, however many times it was amended.
- The colored bars
Every bar on this page splits by how the money moves:
Direct payments