Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents

Under this Initiative, the Centers for Medicare & Medicaid Services (CMS) will select eligible organizations to test a series of evidence-based clinical interventions.

The goal of these interventions is to improve the health and health care among nursing facility residents and ultimately reduce


avoidable inpatient hospital admissions.

Successful applicants will implement such interventions that will have the following objectives:
1) Reduce the frequency of avoidable hospital admissions and readmissions; 2) Improve resident health outcomes; 3) Improve the process of transitioning between inpatient hospitals and nursing facilities; and 4) Reduce overall health care spending without restricting access to care or choice of providers.

The interventions shall primarily target long-stay Medicare-Medicaid enrollees in Medicare-Medicaid certified nursing facilities, rather than those likely to experience only a brief post-acute stay and then return home.

Who's Eligible

Obtain Full Opportunity Text:
Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents

Additional Information of Eligibility:
CMS will consider applications from organizations (referred to as enhanced care & coordination providers) that demonstrate the capacity to adequately implement the types of initiatives described above.

Enhanced care & coordination providers may include, but are 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, and will not apply to beneficiaries enrolled in Medicare Advantage); - 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 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 are excluded from serving as enhanced care & coordination providers under this cooperative agreement.

Legal Status: To be eligible, an organization must be recognized as a single legal entity by the State where it is incorporated, and must have a unique Tax Identification Number (TIN) designated to receive payment.

The organization must have a governing body capable of entering into a cooperative agreement with CMS on behalf of its members.

Full Opportunity Web Address:

Contact: Contact CenterPhone Number: 1-800-518-4726Hours of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Standard

Agency Email Description: Customer Support

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