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 Care Coordination Grant Program Aimed At Reducing Hospitalizations

​A new $128 million grant program, announced yesterday by the Centers for Medicare & Medicaid Services (CMS), is aimed at reducing avoidable hospitalizations among dual-eligible nursing home residents. The four-year program relies on partnerships between nursing homes and organizations to provide “enhanced onsite services and supports” to residents.

Eligible organizations may be for-profit or not-for-profit physician practices or care management organizations, and “must offer evidence-based interventions that will help facilities reduce avoidable hospitalizations.” These “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. 

Dubbed the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, it will be run collaboratively by the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation. The enhanced care & coordination providers will be paid by CMS under contract.

All enhanced care & coordination providers in this initiative must offer the following:

  • 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. 

Although the agency says it does not want to be prescriptive about a specific clinical model of care to be utilized, it cites past demonstrations “that have reduced avoidable hospitalizations by deploying nurse practitioners in nursing facilities to manage residents’ medical needs on the spot, when possible.”

In addition, CMS points to other initiatives that have implemented quality improvement and communication tools to identify, assess, communicate, and document changes in resident status. 

According to Melanie Bella, director of CMS’ Medicare-Medicaid Coordination Office, “All interventions must have an evidence base, and there are certain things we expect. For example, we expect that, working in cooperation with providers, the entities will be facilitating residents’ transitions to and from hospitals and nursing homes. They will also be doing pretty extensive coordination and improvement and management and monitoring of prescription drugs, especially psychotropic drugs,” she says.

“We are excited about testing new care models and to see what entities in the field are going to propose; we look to applicants to really share with us what those best practices are,” says Bella.

As for nursing home providers, they should look at the grant program as an opportunity to “collaborate with an entity that will provide onsite support.”

The initiative will run from August 2012 to August 2016. Organizations interested in applying to participate 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.

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