Initiative to Reduce Avoidable
Hospitalizations among Nursing Facility
B - Could fund technology as a primary component of the budget, if the agency receiving the grant chooses to use it for that purpose.
U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS)
Under this program, the Centers for Medicare and 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:
- Reduce the frequency of avoidable hospital admissions and re-admissions;
- 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 of choice 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. These activities directly support the CMS Center for Medicare and Medicaid Innovation goals to test models of care that deliver better healthcare, better health and reduced costs through improvement.
CMS is not prescribing any specific clinical model; it is allowing applicants to propose interventions to meet the cooperative agreement's objectives. However, all interventions must include the following activities:
- Hire staff who shall maintain a physical presence at nursing facilities and who shall partner with nursing facility staff to implement preventative services and improve recognition, assessment, and management of conditions such as pneumonia, congestive heart failure, chronic obstructive pulmonary disease and asthma, urinary tract infections, dehydration, skin ulcers, falls, and other common causes of avoidable hospitalizations.
- Work in cooperation with existing providers, including residents' primary care providers, nursing facility staff, and families to implement best practices and improve the overall quality of nursing facility care, focusing on quality improvement activities that most directly relate to avoidable hospitalizations.
- Facilitate residents' transitions to and from inpatient hospitals and nursing facilities, including facilitating timely and complete exchange of health information among providers and providing support for residents and nursing facility staff to support successful discharge to the community as appropriate.
- Provide support for improved communication and coordination among hospital staff (including attending physicians), nursing facility staff, residents' primary care providers and other specialists, and pharmacies.
- Coordinate and improve management and monitoring of prescription drugs to reduce risk of poly-pharmacy and adverse drug events for residents, including inappropriate prescribing of psychotropic drugs.
All interventions must also:
- Demonstrate a strong evidence base.
- Demonstrate strong potential for replication and sustainability in other communities and institutions.
- Supplement (rather than replace) existing care provided by nursing facility staff.
- Coordinate closely with State Medicaid and State survey and certification agencies and State public health and health reform efforts, including other CMS demonstrations and waiver.
- Allow for participation by nursing facility residents without any need for residents or their families to change providers or enroll in a health plan. Residents will be able to opt-out from participating, if they choose.
History of Funding
None is available.
Proposed interventions may also include, but are not limited to:
- Education efforts with families/caregivers
- Support for residents and nursing facility staff to facilitate a successful discharge to the community as appropriate
- Health information technology tools to support sharing of care summaries across transitions in care and maintenance of accurate, up to date medication lists.
- Enhanced behavioral health assessments, treatments and management.
CMS will consider applications from organizations that demonstrate the capacity to adequately implement the types of initiatives that will be funded through this program. Enhanced care and 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
- Public or not for profit organizations, such as Aging and Disability Resource Centers, Area Agencies on Aging, Behavioral Health Organizations, Centers for Independent Living, university or others.
- Integrated delivery networks, if they extend their networks to include unaffiliated nursing facilities.
The deadline to submit a letter of intent to apply is 3:00 p.m. Eastern Standard Time (EST) on May 7, 2012. The deadline to submit a full application is June 14, 2012. The application must be submitted no later than 3:00 p.m. EST.
Total funding for this Initiative is up to $128 million to support a diverse portfolio of evidence-based clinical interventions to improve the health and health care among nursing facility residents and ultimately reduce avoidable inpatient hospital admissions. The Medicare-Medicaid Coordination Office expects to make awards ranging from $5 million to $30 million each to cover a four-year cooperative agreement period of performance, and CMS reserves the right to award less or more depending on the scope and nature of the individual applications received. Awardees may not receive the total award amount requested but may be asked to revise the work plan and budget to reflect the funding that CMS will award. Awardees are not required to make a State match contribution to the design, development, and/or
implementation of the cooperative agreement.
Recent FUNDED Articles
You have not selected any grants to Add
Please select at least one grant to continue.
The selected grant has been added to your
One of the benefits of purchasing an UPstream™ subscription
generating professional research reports in Microsoft® Word or Adobe® PDF
Generating research reports allows you to capture all the grant data as
well as a nice set of instructions on how to read these reports
Watchlists and Grant Progress
With an UPstream™
you can add grants to your
own personal Watchlist. By adding grants to your watchlist, you will
receive emails about updates to your grants, be able to track your
grant's progress from watching to awards, and can easily manage any
step in the process through simplified workflows.
Email this Grant
With an UPstream™
, you can email grant details, a research report,
and relevant links to yourself or others so that you never lose your
details again. Emailing grants is a great way to keep a copy of the
current details so that when you are ready to start seeking funding
you already know where to go