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CMS announces program to improve nursing care facility quality

Posted on September 27, 2012 | No Comments

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Key Developments
Implementation Briefs

The Centers for Medicare & Medicaid Services (CMS) announced seven awards partnering with 145 nursing facilities to implement the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. The CMS initiative will test models to improve health care delivery quality and reduce the number of preventable rehospitalizations among nursing facility residents. The initiative will fund organizations to provide additional support to members of nursing facility communities.

Many nursing facility residents are enrolled in both Medicaid and Medicare, and are thus known as dual eligibles. Dual eligibles are the most chronically ill patients served by the two programs. Research found that approximately 45 percent of hospitalizations among duals receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided. Total costs for these potentially avoidable hospitalizations for Medicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion.

CMS will partner with seven organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and State Medicaid programs to provide better quality of care in nursing facilities.

For more information on the initiative, click here.

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Today, the U.S. Department of Health and Human Services (HHS) announced that Massachusetts will become the first State to partner with the Centers for Medicare & Medicaid Services (CMS) to test a new model for providing coordinated, patient-centered care to dual eligible individuals enrolled in both Medicare and Medicaid. Massachusetts and CMS will contract with Integrated Care Organizations (ICOs) to oversee the delivery of Medicare, Medicaid and expanded services for Medicare-Medicaid enrollees in Massachusetts. The program is expected to launch on April 1, 2013.
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Jane Hyatt Thorpe and Katherine Jett Hayes recently released an article funded by the Association for Communication Affiliated Plans (ACAP), "A New State Plan Option to Integrate Care and Financing for Persons Dually Eligible for Medicare and Medicaid," which reviews barriers to clinical and financial integration in services for dual eligibles prior to passage of the ACA, identifies models used by states to integrate care through contract and waiver authorities available to CMS prior to passage of the ACA, describes two new demonstrations proposed by CMS through the Medicare-Medicaid Coordination Office and Innovation Center, and introduces a state plan option as a new model for consideration by federal and state policymakers. This new model draws on experience from existing programs and waivers to provide a permanent state plan option for a fully integrated, capitated care model that could be made available to states prior to the completion of the demonstration process begun by the Medicare-Medicaid Coordination Office and Innovation Center.
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