New Initiative to Improve Care for Medicare-Medicaid Nursing Home Patients
Obama Administration sees opportunity for better care of nursing home residents with better coordination - seeking partners
March 15, 2012 - A new initiative to improve care for Medicare and Medicaid patients living in nursing homes was
announced today by the Obama Administration. The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents was
announced in a news release by the Centers for Medicare & Medicaid Services.
The goals are to reduce costly and avoidable hospitalizations among nursing facility residents by funding organizations
that would partner with nursing facilities to provide enhanced on-site services and supports to nursing facility residents.
Nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled in Medicare. Many
are enrolled in both programs. These Medicare-Medicaid enrollees are among the most vulnerable individuals served by the programs and
generally have the most complex health care needs, says CMS.
Research on these enrollees in nursing facilities found that approximately 45% of hospital admissions among those
receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided, accounting for
314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005.
This new initiative works to prevent potentially avoidable hospitalizations by providing better, more cost-effective care
in nursing facilities.
CMS says it has allocated up to $128 million to support a diverse portfolio of these evidence-based interventions.
The initiative will be run collaboratively by the CMS Medicare-Medicaid Coordination Office and the Center for Medicare
and Medicaid Innovation, both created by the Affordable Care Act (Obamacare) to improve the quality and costs of care in the Medicare and
Medicaid programs.
“Being readmitted to a hospital is very difficult for low-income seniors, people with disabilities and their families,”
said Acting Administrator Marilyn Tavenner.
“Through this initiative, we will work with nursing facilities and hospitals to provide better, person-centered care. By
catching and resolving issues early, we can help people avoid costly and stressful hospitalizations."
Through this initiative, CMS will partner with independent organizations to improve care for long-stay nursing facility
residents. These organizations will collaborate with nursing facilities and States to provide coordinated, person-centered care with the goal
of reducing avoidable hospital stays. Eligible organizations can include physician practices, care management organizations, and other public
and not-for-profit entities.
Each organization will propose its own evidence-based intervention and improvement strategy. All participants will have
staff on-site at nursing facilities to provide preventive services and improve coordination and communication among providers, helping to
provide the resident with a more seamless transition between care settings.
CMS issued a Request for Applications today and organizations interested in participating in this initiative must submit
an application by June 14, 2012. More information about this initiative, including the Request for Applications, is available at:
http://innovation.cms.gov/initiatives/rahnfr, or by searching for CFDA 93.621 at:
www.grants.gov.
The following Fact Sheet includes more information for those organizations interested in participating in the initiative.
Fact Sheet: CMS Announces New Initiative to Reduce Costly and Avoidable Hospitalizations Announcement of Request for
Applications
Overview
In March 2012, the Centers for Medicare & Medicaid Services (CMS) issued a request for applications to participate in the
Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. This new effort aims to improve the quality of care for
people residing in nursing facilities.
CMS will support organizations that will partner with nursing facilities to implement evidence-based interventions to
improve the quality and costs of care. The initiative is focused on long-stay nursing facility residents who are enrolled in the Medicare and
Medicaid programs, with the goal of reducing avoidable inpatient hospitalizations.
Background
Too often, nursing facility residents experience potentially avoidable inpatient hospitalizations. These hospitalizations
are expensive, disruptive and disorienting for frail elders and people with disabilities. Nursing facility residents are especially vulnerable
to the risks that accompany hospital stays and transitions between nursing facilities and hospitals, including medication errors and
hospital-acquired infections.
Many nursing facility residents are enrolled in both the Medicare and Medicaid programs (Medicare-Medicaid enrollees).
CMS research on Medicare-Medicaid enrollees in nursing facilities found that approximately 45% of hospital admissions among those receiving
either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided, accounting for 314,000
potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005.
Initiative
Through this initiative, CMS will partner with eligible, independent, non-nursing facility organizations (referred to as
“enhanced care & coordination providers”) to implement evidence-based interventions that reduce avoidable hospitalizations. Eligible
organizations can include physician practices, care management organizations, and other public and not-for-profit entities.
The enhanced care & coordination providers will collaborate with States and nursing facilities, with each enhanced care &
coordination provider implementing its intervention in at least 15 partnering nursing facilities.
Applicants will propose an intervention that meets the objectives of the initiative, which those selected will then
implement. All enhanced care & coordination providers in this initiative must:
● Hire staff who maintain a physical presence at nursing facilities and partner with nursing facility staff to
implement preventive services;
● Work in cooperation with existing providers;
● Facilitate residents’ transitions to and from inpatient hospitals and nursing facilities;
● Provide support for improved communication and coordination among existing providers; and
● Coordinate and improve management and monitoring of prescription drugs, including psychotropic drugs.
For example, past demonstrations have reduced avoidable hospitalizations by deploying nurse practitioners in nursing
facilities to manage residents’ medical needs on the spot, when possible. Others have implemented quality improvement and communications tools
to identify, assess, communicate, and document changes in resident status.
Interventions will be evaluated for their effectiveness in improving health outcomes and providing residents with a
better care experience. This initiative is expected to last for four years from August 2012 to August 2016.
Application Process
Organizations interested in applying to participate in this initiative must submit a proposal by June 14, 2012. The
Request for Applications is available by searching for CFDA Number 93.621 at
www.grants.gov. Applicants must include letters of support from the relevant State Medicaid
Director and State Survey & Certification Director and letters of intent from at least 15 nursing facility partners in the same State. Notices
of Intent to Apply are due April 30, 2012.
CMS will give preference to applications for initiatives in geographic locations where there are high Medicare costs,
high hospital readmission rates, and where Medicare-Medicaid enrollees account for a high percentage of nursing facility residents.
Additional Information
This initiative was developed jointly by the CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) and the
Medicare-Medicaid Coordination Office, which were created by the Affordable Care Act. Both offices offer various opportunities and supports to
further efforts to strengthen the Medicare and Medicaid programs and improve care. The Innovation Center works across the Medicare and
Medicaid programs and Children’s Health Insurance Program to deliver better care for individuals, better health for populations, and lower
growth in expenditures. The Medicare-Medicaid Coordination Office works to better integrate the Medicare and Medicaid programs to ensure full
access to seamless, high-quality care in a cost-effective manner.
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March 15, 2012 - A new initiative to improve care for Medicare and Medicaid patients living in nursing homes was
announced today by the Obama Administration. The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents was
announced in a news release by the Centers for Medicare & Medicaid Services.
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