Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents (NFI)





The Medicare-Medicaid Coordination Office, in collaboration with the Center for Medicare & Medicaid Innovation, is helping to improve the quality of care for people in long-term care (LTC) facilities by reducing potentially avoidable inpatient hospitalizations.  

The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is focused on long-stay LTC facility residents who are enrolled in the Medicare and Medicaid programs. The Initiative supports organizations that partner with LTC facilities to implement evidence-based interventions that both improve care and lower costs.


LTC facility residents often experience potentially avoidable hospital transfers. Unnecessary hospitalizations are expensive, disruptive, and disorienting for frail elders and people with disabilities. LTC facility residents are especially vulnerable to the risks that accompany hospital stays and transitions between nursing facilities and hospitals, including medication errors and hospital-acquired infections.

Many LTC facility residents are enrolled in both the Medicare and Medicaid programs (Medicare-Medicaid enrollees). CMS research on this population has repeatedly found that a large number of hospital admissions could have been avoided. More information can be found at the links below:  


Initiative Details

CMS is partnering with several organizations, referred to as "enhanced care & coordination providers" or "ECCPs", to implement evidence-based clinical and educational interventions that reduce avoidable hospitalizations.

Learn more about ECCPs

While each ECCP's intervention has unique features, all include:

  • Employing staff who will maintain a physical presence on site at LTC facilities; 
  • Allowing for participation by LTC facility residents without any need for residents to change providers or enroll in a health plan; and
  • Supplementing (rather than replacing) existing care provided by LTC facility staff.  

Phase One: Improving Clinical Care

Between 2012 and 2016, CMS partnered with seven ECCPs, each providing on-site services in a group of partnering nursing facilities. Five of the organizations focused on direct care, and two focused on staff training.

Learn more about Phase One

Evaluation Reports

An independent evaluation found "persuasive evidence of the Initiative's effectiveness in reducing hospital inpatient admissions, ED visits, and hospitalization-related Medicare expenditures."

Learn more about evaluation reports

Phase Two: Adding Payment Reform

On August 27, 2015, CMS announced a new funding opportunity to launch the second phase of this Initiative.   

The intent of the new payment model is to reduce potentially-avoidable hospitalizations by funding higher-intensity treatment services in nursing facilities for residents who may otherwise be hospitalized upon an acute change in condition. 

Learn more about Phase Two


Participating Sites

On March 24, 2016, CMS announced cooperative agreements with the six organizations below to implement Phase Two of the Initiative.

Alabama Quality Assurance Foundation – Alabama

HealthInsight of Nevada – Nevada and Colorado

Indiana University – Indiana

The Curators of the University of Missouri – Missouri 

The Greater New York Hospital Foundation, Inc. – New York 

University of Pittsburgh Medical Center (UPMC) Community Provider Services - Pennsylvania

Over 250 LTC facilities have been selected to implement this phase of the Initiative.  


Contact us

For more information or questions about this Initiative, email

Page Last Modified:
05/18/2020 07:17 AM