CMS expands community-based transitional care efforts

Another 20 groups and organizations have joined the Community-based Care Transitions Program (CCTP), the Centers for Medicare & Medicaid Services announced yesterday.

Participants in the five-year program sign two-year renewable agreements with CMS to effectively manage Medicare patients' transitions between care settings and improve quality of care. Up to $500 million in funding is available over the life of the program.

Community-based organizations are paid based on the cost of care-transition services provided, as well as the cost of making systemic changes at the hospital level, CMS says.

To date, the program includes more than 100 organizations, some of which are in partnerships. Final applications were due last September.

Hospitals were slow to embrace the transitional care program, but a few are participating or leading local CCTP efforts.

"The fundamental flaw in this model is that hospitals are the only entity eligible to be penalized for readmissions, yet hospitals are not eligible to directly receive any of the technical assistance funds available," Lisa Grabert, American Hospital Association senior associate director for policy, said last fall.

The list of new participants is below:

  • Top of Alabama Regional Council of Governments - Alabama

  • Sun Health - Arizona

  • Community SeniorServ - California

  • Jewish Home for the Aging Geriatric Services Inc. - California

  • Sonoma County Area Agency on Aging - California

  • Upper Arkansas Area Council of Governments - Colorado

  • LifeSpan Resources Inc. - Indiana

  • Brewster Place - Kansas

  • Green River Area Development District - Kentucky

  • Kentucky Appalachian Transitions Services - Kentucky

  • Capital Area Agency on Aging - Louisiana

  • Valley Area Agency on Aging - Michigan

  • Central New Jersey Care Transition Program - New Jersey

  • Dominican Sisters Family Health Service Inc. - New York

  • Area Office on Aging of Northwestern Ohio Inc. - Ohio

  • PSA 3 Area on Aging - Ohio

  • York County Area Agency on Aging - Pennsylvania

  • Carelink Inc. - Rhode Island

  • Area Agency on Aging of Southeast Texas - Texas

  • Deep East Texas Council of Governments Area Agency on Aging -Texas

To learn more:
- see the CMS announcement
- view the complete list
- check out these CCTP FAQs