Affordable Care Act Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents

 

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.

General information about this opportunity
Last Known Status
Active
Program Number
93.621
Federal Agency/Office
Centers For Medicare and Medicaid Services, Department of Health and Human Services
Type(s) of Assistance Offered
B - Project Grants
Program Accomplishments
Not applicable.
Authorization
Affordable Care Act, Public Law 111-148, section 3021.
Who is eligible to apply/benefit from this assistance?
Applicant Eligibility
Applicants eligible to be enhanced care & coordination providers included, but were not limited to: o Organizations that provide care coordination, case management, or related services; o Medical care providers, such as physician practices; o Health plans (although this initiative will not be capitated managed care); o 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; o 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.
Beneficiary Eligibility
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).
Credentials/Documentation
Six (6) organizations, which fulfilled these requirements (below), have already been selected for this Initiative. LTC facilities must execute a participation agreement with the ECCP prior to participating in the payment model. This agreement must also attest or state the LTC facility's commitment to meeting and maintaining the above criteria through the end of the Initiative (we note that a facility's ability to meet the demographic criteria of an average daily census of greater than 80 residents with greater than 40% of the total LTC facility census as long-stay Medicare enrollees in traditional FFS Medicare, may be outside of the facility's control and may fluctuate throughout the period of performance. CMS will address these fluctuations on a case by case basis). Executed agreements between LTC facilities and ECCPs for this phase of the Initiative may be submitted in lieu of a Letter of Intent (executed agreements preferred). For LTC facilities partnering with ECCPs for phase one of the Initiative, agreements for phase two should not supersede the existing agreements for phase one. Rather, these new agreements should supplement what has already been agreed upon. In addition to this documentation, the application is expected to address how the applicant will implement the cooperative agreement program, including how it will meet the clinical intervention requirements, and ultimately, meet the objectives of this Initiative. 2 CFR 200, Subpart E - Cost Principles applies to this program.
What is the process for applying and being award this assistance?
Pre-Application Procedure
Preapplication coordination is required. This program is excluded from coverage under E.O. 12372.
Application Procedure
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. Not Applicable
Award Procedure
Six (6) organizations, which completed the review process as outlined below, have already been selected for this Initiative. The review process included the following: (1) An independent, objective review of applications will be conducted. The CMS review panel will assess the application based on the review criteria outlined in section V.1 above to determine the merits of the application and the extent to which it furthers the purposes of the Initiative. The review panel comments and recommendations will be condensed into a summary statement that will assist CMS in making the final award decision. CMS will use the information to judge the likelihood that the project will be successfully implemented and will have tangible, beneficial outcomes. (2) A program integrity screening of the applicant, its affiliates, or any other relevant individuals or entities to determine if prior investigations, CMS administrative actions, or claims analysis indicate these entities present a high risk for fraud and abuse under the Initiative. (3) Applications determined to be ineligible, incomplete, and/or non-responsive based on the initial screening may be eliminated from further review. However, the CMS/OAGM/GMO, in his or her sole discretion, may continue the review process for an ineligible application if it is in the best interest of the government to meet the objectives of the program
Deadlines
March 21, 2016 to October 23, 2020 The period of performance is September 24, 2012 through September 23, 2016. Six (6) organizations, which fulfilled these requirements, have already been selected for this Initiative. Potential applicants were required to submit a non-binding Notice of Intent to Apply by September 9, 2015. Eastern Standard Tim in order to be eligible for a funding award. Applications were due by October 29, 2015, 5:00 p.m. Eastern Standard Time.
Approval/Disapproval Decision Time
Cooperative agreement awards were made on September 24, 2012.
Appeals
Not applicable.
Renewals
Not applicable.
How are proposals selected?
See Award Procedures (093)
How may assistance be used?
Under the Cooperative Agreements, CMS funded “enhanced care & coordination providers” to implement an intervention that meets the objectives of the Initiative. 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 preventive 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; and • Coordinate and improve management and monitoring of prescription drugs to reduce risk of polypharmacy 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 waivers; and • 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.) The enhanced care & coordination providers must collaborate with State Medicaid and State survey and certification agencies and participating nursing facilities, with each enhanced care & coordination provider implementing its intervention in at least 15 Medicare- and Medicaid-certified nursing facilities in the same State. In addition to implementing the interventions and executing other activities outlined in the Initiative funding opportunity announcement, enhanced care & coordination providers must also participate in ongoing learning and diffusion activities and cooperate with operations support and evaluation efforts, including adapting models based on needed mid-course corrections.
What are the requirements after being awarded this opportunity?
Reporting
Performance Reports: The six (6) award recipients must comply with the report requirements as outlined below: Enhanced care & coordination providers will be measured and funded based on their ability to execute their proposed work plan. The components of the work plan include, but are not limited to: • Meeting proposed milestones and deliverables as outlined in the work plan and communications plan; • Satisfying all Enhanced Care & Coordination Provider Activities, including a) submitting quarterly progress reports as scheduled and providing complete and accurate information for all required data fields in those reports and b) submitting timely, complete, and accurate semi-annual funding reports that show efficient use of cooperative agreement funds; • Participating in ongoing learning and diffusion activities, including those offered through the CMS Learning Community; and • Cooperating with operations support and evaluation efforts, including adapting models based on needed midcourse corrections. CMS will regularly monitor operations. Awardees will be required to cooperate in providing the necessary data elements to CMS. CMS will contract with independent entities to assist in monitoring the programs and to conduct an independent evaluation.
Auditing
Not applicable.
Records
The six (6) award recipients must comply with the report requirements as outlined below: Enhanced care & coordination providers must track data required for quarterly progress reports and semi-annual funding reports.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.

Matching requirements are not applicable to this assistance listing.

MOE requirements are not applicable to this assistance listing.
Length and Time Phasing of Assistance
The project period of performance is 48-months and is expected to last from September 2012 to September 2016. No restriction is placed on the time permitted to spend the money awarded. Awards were made through cooperative agreements.
Who do I contact about this opportunity?
Regional or Local Office
Not Applicable
Headquarters Office
Nicole Perry
7500 Security Blvd.
Baltimore, MD 21214 US
Nicole.Perry@cms.hhs.gov
Phone: 410-786-8786
Financial Information
Account Identification
75-0522-0-1-551
Obligations
(Cooperative Agreements) FY 18$27,614,601.00; FY 19 est $28,092,794.00; FY 20 est $28,004,625.00; FY 17$28,152,584.00; FY 16$5,799,630.00; -
Range and Average of Financial Assistance
The six (6) organizations which received funding are: Alabama Quality Assurance Foundation - Alabama, Comagine Health - Nevada, Indiana University - Indiana, The Curators of the University of Missouri - Missouri, The Greater New York Hospital Foundation, Inc. - New York City, and UPMC Community Provider Services - Pennsylvania. The awards ranged from: $5 million to $25 million to cover a four-year period of performance.
Regulations, Guidelines and Literature
The background provided in the funding opportunity announcement describes relevant literature. A list of references is also included.
Examples of Funded Projects
Not applicable.

 



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