On September 30, the Centers for Medicare & Medicaid Services (CMS) will formally conclude the payment incentives provided to participating nursing facilities and practitioners through the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, or the Nursing Facility Initiative (NFI). CMS created the NFI in 2012 and renewed it for a second phase in 2016. GNYHA Foundation participated in the NFI through its New York–Reducing Avoidable Hospitalizations (NY–RAH) project. Some NY–RAH-participating nursing facilities will continue to receive support for clinical interventions through the end of the year. CMS approved a three-month extension to allow for the completion of NY–RAH processes that had been interrupted by the COVID-19 pandemic.
The NFI was sponsored by the Federal Medicare-Medicaid Coordination Office in collaboration with the CMS Innovation Center. Phase One focused on testing clinical and process improvement interventions to improve outcomes and reduce avoidable hospitalizations for long-stay nursing facility residents. Phase Two tested payment incentives that enabled participating facilities and practitioners to receive additional reimbursement through Medicare Part B for managing the six qualifying conditions onsite to further promote reducing avoidable hospitalizations.
The NY–RAH project was one of seven projects across the US that were part of Phase One, and one of six projects that continued into Phase Two. Through June, the 54 participating New York nursing facilities have received more than $11.5 million in additional Medicare reimbursement through the NFI. Eligible practitioners have also submitted more than 5,000 claims under the payment incentive program to obtain higher reimbursement for visits to New York nursing facilities to address acute changes of conditions in residents. Facilities and practitioners will continue to submit claims and receive NFI payment incentives for care provided through September 30.
GNYHA will use the lessons learned from the NFI and the NY–RAH project to inform future long term/post-acute care policy and advocacy work. For more information on the NY–RAH project, please visit www.nyrah.org or contact Faiza Haq.