Accountable Health Communities Model Overview and Track 1 - - PowerPoint PPT Presentation
Accountable Health Communities Model Overview and Track 1 Requirements Presenters Alexander Billioux, MD, DPhil Simeon L. Niles, JD, MPH Louise M. Amburgey Agenda Accountable Health Communities (AHC) Model Design Model Overview &
Presenters Alexander Billioux, MD, DPhil Simeon L. Niles, JD, MPH Louise M. Amburgey
– Model Overview & Structure – Track 2 & 3 Updates
– Overview – Requirements
– Eligibility Criteria – Application Requirements – Selection Criteria
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– CMS Quality Strategy, 2015 * https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/QualityInitiativesGenInfo/CMS-Quality-Strategy.html
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Care Process Today’s Care Future Care
Identification of health- related social need Ad hoc, depending on whether patient raises concern in clinical encounter Systematic screening of all Medicare and Medicaid beneficiaries Provider response to health-related social need Ad hoc, depending on whether provider is aware of resources in the community Systematic connection to community services through referral or community service navigation Availability of support to help patient resolve health-related social need Ad hoc, depending on whether case manager is available and has capacity given case load and care coordination responsibilities Community service navigation designed to help high-risk beneficiaries overcome barriers to accessing services Availability of community services to address health- related social needs Dependent on fragmented community service system not aligned with beneficiary needs,
difficulty accessing services Aligned community services, data- driven continuous quality improvement and community collaborations to assess and build service capacity
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* This list is not inclusive
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– Identify and partner with clinical delivery sites – Conduct systematic health-related social needs screenings and make referrals – Coordinate and connect community-dwelling beneficiaries who screen positive for certain unmet health-related social needs to community service providers that might be able to address those needs – Align model partners to optimize community capacity to address health-related social needs
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through information dissemination and referral
beneficiaries with accessing services
that community services are available and responsive to the needs
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– Reducing the annual number of beneficiaries applicants are required to screen from 75,000 to 53,000; and – Increasing the maximum funding amount per award recipient from $1 million to $1.17 million over 5 years.
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Target Population Question Being Asked Partners Community-dwelling Medicare and Medicaid beneficiaries with unmet health-related social need(s) Will increasing beneficiary awareness of available community services, through information dissemination and referral, impact total health care costs, inpatient and
utilization and quality of care?
Agencies
providers
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– Hospital – Provider of primary care services – Provider of behavioral health services
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claims data for beneficiaries in the model to CMS, and an overview of the process and timeline for obtaining Medicaid claims data
provide required AHC data in the absence of timely T-MSIS data
duplicative services that are operating in the target area
estimates of Medicaid beneficiary ED utilization in the previous 12 months
consortium
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have received clinical services in the previous 12 months at the clinical delivery site (specifically address the number of each)
utilized the ED two or more times in the previous 12 months
will participate in the model
CMS
dwelling beneficiaries
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– State Medicaid Agency(ies) – Clinical Delivery Sites (hospital, primary care provider, behavioral health treatment facility)
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– Background – Geographic Target Area – Systematic Screenings for Health-Related Social Needs – Risk Stratification – Tailored Community Resource Inventory and Referrals Summary
– Description of capacity to carry out core elements and a description of the process for data collection and reporting for internal quality control and CMS monitoring and evaluation
– State Medicaid Agency Consortium – Clinical Delivery Sites – Community Service Providers
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exceeds more than 15 percent of the total costs of the applicant’s proposed budget.
agreement from the appropriate state Medicaid agencies.
review.
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44 Congress authorizes the program. President requests funds; Congress appropriates them. Federal agency may develop program regulations or guidelines to program implementation. Agency advertises availability of funds. Prospective recipient applies for assistance. Agency reviews applications and selects proposals for funding. Recipient conducts approved project; agency monitors award. Process may be repeated for subawards. Agency closes out the award at the end
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Some examples of substantial involvement by CMS include:
a grant project may continue
involvement during performance
The following actions do not represent substantial involvement:
statutory requirements, and the award terms and conditions
federal funds
standards and sole source procurement
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– EPLS – CCR (Central Contractor Registration)
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– Issue NoA’s – Grant Notes (internal and correspondence) – Amendments (budget reallocations, carryovers, etc.) – FFR Reporting module – Closeout
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12-point with a 14 CPI and may be single spaced. Tables are counted towards the applicable page limits mentioned in Section 4. Eligibility Information of this funding
described in Section 4. Eligibility Information of this funding opportunity announcement: Standard Forms, applicant’s copy of its Letter of Intent for the AHC model (if previously submitted) and the Project Abstract.
reviewed at all.
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detailed cost tables and breakdown for each SF 424A line item. Locate Budget Narrative Form in the Grants Application Package www.Grants.gov
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Prohibited Uses of Cooperative Agreement Funds
Use of cooperative agreement funds in the following ways will result in termination of the applicant’s funding to implement the AHC model:
– To match any other Federal funds. – To fund the provision of social services. – To provide services, equipment, or supports that are the legal responsibility of another party under Federal, State, or Tribal law (e.g., vocational rehabilitation or education services) or under any civil rights laws. Such legal responsibilities include, but are not limited to, modifications of a workplace or other reasonable accommodations that are a specific obligation of the employer or other party. – To provide goods or services not allocable to the approved project. – To supplant existing State, local, Tribal or private funding of infrastructure or services, such as staff salaries, etc. – To be used by local entities to satisfy state matching requirements. – To pay for construction. – To pay for capital expenditures for improvements to land, buildings, or equipment which materially increase their value or useful life as a direct cost, except with the prior written approval of the Federal awarding agency. – To pay for the cost of independent research and development, including their proportionate share of indirect costs (unallowable in accordance with 45 CFR 75.476). – To use as profit to any award recipient even if the award recipient is a commercial organization, (unallowable in accordance with 45 CFR 75.215(b)), except for grants awarded under the Small Business Innovative Research (SBIR) and Small Business Technology Transfer Research (STTR) programs (15 U.S.C. 638). Profit is any amount in excess of allowable direct and indirect costs.
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Louise M Amburgey U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services E-mail: OAGM-AHC@cms.hhs.gov Susan Jackson U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services E-mail: accountablehealthcommunities@cms.hhs.gov
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