Last updated: November 2026
Age-Friendly Health System recognition readiness is the work of describing how a hospital, practice, clinic or nursing home already delivers four elements of care to older adults, closing the gaps, and keeping the evidence that IHI recognition asks for. Integral Healthcare Solutions (IHS) drafts the 4Ms Care Description, the supporting policies and workflows, and the counting method for your leaders and clinicians to approve; your organization submits.
IHS works in three practice lines: accreditation consulting, compliance services and program development. This page sits in the accreditation line because the readiness method is the same, although recognition is not accreditation.
What is Age-Friendly Health System recognition?
Age-Friendly Health Systems is an initiative led by the Institute for Healthcare Improvement (IHI) and The John A. Hartford Foundation, developed with the American Hospital Association and the Catholic Health Association of the United States. Its framework is the 4Ms: What Matters, Medication, Mentation and Mobility (IHI program page, opened 2026-11-05).
IHI recognizes sites at two levels (IHI recognition page, opened 2026-11-05):
- Level 1, Participant. The site completes a 4Ms Care Description for its care setting, which lays out how it will assess, document and act on all four Ms, and submits it to IHI by email or through IHI's electronic form. IHI says the description can be a plan the site will test and work toward performing reliably.
- Level 2, Committed to Care Excellence. The site must first earn Level 1 and be told its description aligns with IHI's guide. It then submits counts of older adults who received care that included all four Ms, for at least three months. The counts must come from months after the description was approved, and the months need not be consecutive.
IHI says submissions are reviewed throughout the month and that applicants should receive a status email within three weeks. Its page describes no renewal cycle or expiration date, and says recognized sites do not need to take additional action to sustain their recognition.
What is the CMS Age Friendly Hospital measure, and how does it differ?
The CMS Age Friendly Hospital measure is a yearly attestation for hospitals in the IQR Program; IHI recognition is a voluntary program run by IHI. In the fiscal year 2025 IPPS/LTCH PPS final rule, CMS wrote: “After consideration of the public comments we received, we are finalizing the Age Friendly Hospital measure as proposed beginning with the CY 2025 reporting period/FY 2027 payment determination.” (89 FR 69525, Federal Register text opened 2026-11-05). The measure sits in the Hospital Inpatient Quality Reporting (IQR) Program. IHI recognition is a separate, voluntary program.
Facts from that rule, in IHS’s words:
- The measure assesses a hospital's commitment to improving care for patients 65 or older receiving services in the hospital, operating room or emergency department, and it has five domains (89 FR 69517).
- The domains concern patient goals, medication management, frailty, social vulnerability and leadership and governance commitment (89 FR 69518).
- A hospital attests for each hospital reported under its CMS certification number. A domain earns one point, and CMS says no partial points are possible: Domain 3, frailty screening and intervention, has four attestation statements, and all four must be met to earn its point (89 FR 69519).
- Hospitals submit once a year through a CMS-approved web-based tool in the Hospital Quality Reporting System (89 FR 69519).
- CMS said that because the IQR Program pays for reporting, hospitals would receive credit for reporting their results regardless of their answers to the attestation questions (89 FR 69519).
The rule text IHS read covers the CY 2025 reporting period. Under 42 CFR 412.140(g)(1), “Quality measures adopted for the Hospital IQR Program measure set for a previous payment determination year are retained for use in subsequent payment determination years, except when they are removed, suspended, or replaced as set forth in paragraphs (g)(2) and (3) of this section.” (eCFR text built 2026-11-04). IHS did not read the QualityNet measure specification or submission calendar; confirm both there.
Who needs it and what triggers it
Two groups come to this work.
- An acute care hospital preparing its Age Friendly Hospital attestation. It needs a domain-by-domain evidence file and policies that match what it attests.
- A hospital, practice, convenient care clinic or nursing home that wants IHI recognition. IHI’s recognition page lists these settings and also lists worksheets for home health and hospice. Pharmacies apply through ASCP’s Age-Friendly Pharmacy Recognition, and other locations email IHI to confirm eligibility.
How IHS helps
IHS tests current practice against the framework you are pursuing. The method:
- Gap assessment of your care setting against the four Ms and, for a hospital, against the five CMS domains you attest to.
- Evidence index tying each element to the policy, order set, screening tool, record field or report that shows it.
- Drafts of the 4Ms Care Description for your setting, the policies and workflows behind it, and a count method for Level 2, for your leaders and clinicians to approve.
- Review of draft attestations against the evidence, so every statement your hospital affirms has a document behind it.
- Readiness support before you submit.
Your organization supplies its policies, screening tools, medication review procedures, EHR field lists and reports, committee minutes, quality data, and the names of its champions and governance bodies. Your clinicians approve clinical content, your IT team builds any EHR change, and your named contact submits to IHI or CMS.
The limit: IHS does not decide recognition and does not communicate with IHI or CMS.
What to have ready
These are IHS’s suggested file labels, not the full set of IHI or CMS requirements.
| Item | Why it matters |
|---|---|
| Care setting chosen and the matching IHI worksheet identified | IHI’s recognition page directs each site to the worksheet for its care setting. |
| A written account of how you elicit What Matters and where it is recorded | One of the four Ms in IHI’s framework; CMS Domain 1 concerns patient goals. |
| A medication review process for older adults, with an owner | The Medication M; CMS Domain 2 concerns medication management. |
| Screening and response procedures for mentation and mobility | The Mentation and Mobility Ms; CMS Domain 3 concerns frailty screening and intervention and has four statements. |
| Social vulnerability screening and what happens after a positive screen | CMS Domain 4 (hospitals). |
| A named leader or committee and a record of its meetings | CMS Domain 5 concerns leadership and governance commitment. |
| A method to count older adults who received all four Ms, by month | Level 2 counts come from months after approval; IHI lists observation, chart review or an EHR report as ways to measure. |
| For a hospital, the CCN list and who signs each attestation | The attestation is made for each hospital reported under its CMS certification number. |
How it compares
These programs overlap. IHS does not tell you which to pursue.
- IHI recognition is voluntary, available to several care settings, and tracks the 4Ms.
- The CMS Age Friendly Hospital measure is a federal reporting measure for hospitals in the IQR Program, with its own five-domain structure.
- Geriatric Surgery Verification is a program of the American College of Surgeons. IHS has a separate page on ACS Geriatric Surgery Verification, which covers that program; this page covers IHI recognition and the CMS measure.
What it costs
IHI’s recognition page says there is no cost for recognition or implementation support (page opened 2026-11-05). Verify current terms with IHI. A CMS payment rule applies to quality data submission generally: under 42 CFR 412.64(d)(2)(i)(C), the market basket update is reduced for fiscal year 2015 and subsequent fiscal years by one-fourth, and under (d)(2)(ii) the reduction applies only to the fiscal year involved. The text applies to a subsection (d) hospital that does not submit quality data on a quarterly basis to CMS, in the form and manner specified by CMS. Whether a particular missed submission triggers that reduction is a question for your hospital's counsel and CMS; IHS does not opine.
IHS scopes each engagement after a free introductory call. Include internal staff time in your budget.
What this is not
IHS is not IHI and does not grant recognition. IHI calls this recognition, and IHS does not treat it as accreditation.
This page is not legal advice, and it does not tell a hospital what to attest. IHS is a consulting firm, not a law firm.
IHS does not guarantee an IHI or CMS outcome. IHS drafts clinical content for your clinicians to approve and does not file anything with IHI or CMS. Your organization submits.
Frequently asked questions
What is Age-Friendly Health System recognition?
It is recognition from the Institute for Healthcare Improvement (IHI) that a care setting has described, and then shown, reliable delivery of the four elements of age-friendly care: What Matters, Medication, Mentation and Mobility. IHI offers two levels. Recognition is not accreditation and it is not a CMS program.
Is the CMS Age Friendly Hospital measure the same as IHI recognition?
No. The CMS measure is an attestation measure in the Hospital Inpatient Quality Reporting Program, finalized in the fiscal year 2025 IPPS/LTCH PPS final rule. IHI recognition is a separate, voluntary program. CMS says the measure's elements align with the IHI and Hartford Foundation initiative; the rule passage IHS read does not say IHI recognition satisfies the measure.
How long does Level 1 recognition take?
IHI's recognition page says submissions are reviewed throughout the month and that applicants should receive a status email within three weeks (page opened 2026-11-05).
What does Level 2 require?
A site must first earn Level 1. It then submits counts of older adults who received care that included all four Ms, for at least three months. IHI's page says the counts must come from months after the description was approved and that the months do not have to be consecutive (page opened 2026-11-05).
Does an Age-Friendly recognition expire?
The IHI recognition page does not describe a renewal or an expiration date. It says recognized sites do not need to take additional action to sustain their recognition, (page opened 2026-11-05).
Can a hospital meet the CMS measure by earning IHI recognition?
The Federal Register text IHS read does not say so. Under the measure, a hospital attests to five domains, earns a point only for a domain whose attestation statements it can all affirm, and reports once a year through the Hospital Quality Reporting System.
What is the payment consequence of not reporting quality data?
Under 42 CFR 412.64(d)(2)(i)(C), a subsection (d) hospital that does not submit quality data on a quarterly basis to CMS, in the form and manner specified by CMS, has the percentage increase in its market basket index reduced by one-fourth for fiscal year 2015 and subsequent fiscal years. CMS also said in the rule that credit is given for reporting regardless of the answers to the attestation questions.
Who approves the clinical content IHS drafts?
Your hospital or practice leaders and clinicians. IHS drafts the 4Ms Care Description, policies, workflows and count method for them to review, and nothing clinical takes effect until your clinicians approve it.
Does IHS contact IHI or CMS for us?
No. IHS does not communicate with IHI or CMS. Your organization's named contact submits the worksheet to IHI and makes any CMS submission, and IHS prepares the documents behind each.
What does it cost?
IHI's recognition page says there is no cost for recognition or implementation support (page opened 2026-11-05). Verify current terms with IHI. IHS scopes each engagement after a free introductory call, and your internal staff time belongs in the plan.