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Centers for Medicare & Medicaid Services: Accountable Health Communities Track 1 – Awareness

Deadline: November 3, 2016

The Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI) will assess whether systematically identifying the health-related social needs of community-dwelling Medicare and Medicaid beneficiaries, including those who are dually eligible, and addressing their identified needs, impacts those community-dwelling beneficiaries’ total health care costs and their inpatient and outpatient health care utilization. The Accountable Health Communities (AHC) model addresses a gap in the current delivery system by funding interventions that connect community-dwelling beneficiaries with community services. The AHC model tests three community-focused interventions of varying intensity and their ability to impact total health care costs and inpatient and outpatient health care utilization. The model will engage community dwelling Medicare and Medicaid beneficiaries of all ages (children and adults). Note: This funding opportunity is a second call for proposals, specifically for Track 1 – Awareness. The application period for Track 2 – Assistance, and Track 3 – Alignment is now closed.

For the purposes of the AHC model, a community-dwelling beneficiary is a Medicare and/or Medicaid beneficiary, regardless of age, functional status, and cultural or linguistic diversity, who is not residing in a correctional facility or long-term care institution (e.g., nursing facility), who seeks health care at a participating clinical delivery site and who lives within the geographic target area specified by the applicant. This definition includes children and adults covered under Medicaid through presumptive eligibility, and all community-dwelling beneficiaries that are dually eligible.

For this funding opportunity, AHC Track 1 – Awareness includes the following elements: (1) screening of community dwelling beneficiaries to identify certain unmet health-related social needs; and (2) referral of community-dwelling beneficiaries to increase awareness of community services. Award recipients will be expected to achieve the following AHC programmatic goals for Track 1:

  • Increase community-dwelling beneficiaries’ awareness of community resources that might be available to address their unmet health-related social needs
  • Reduce inpatient and outpatient health care utilization and the total costs of health care by addressing unmet health-related social needs through referral and connection to community services.

Amount: Up to $14,000,000 will be available to fund twelve cooperative agreements of up to $1,170,000 each.

Eligibility: Community-based organizations, healthcare provider practices, hospitals and health systems, institutions of higher education, local government entities, tribal organizations, and for-profit and not-for-profit local and national entities with the capacity to develop and maintain relationships with clinical delivery sites and community service providers.

Link: http://www.grants.gov/web/grants/view-opportunity.html?oppId=288650

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