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A Centers for Medicare and Medicaid Services (CMS) memorandum (pdf) issued on September 30 lists the categories of approved uses of Civil Money Penalty (CMP) funds by state.

Topping the list of nine “categorically permitted uses” — which do not require prior approval from CMS — is the use of CMP funds to promote “culture change” in projects that involve multiple nursing homes.

“This announcement provides an important opportunity for state culture change coalitions to tap into CMP monies to support training and culture change initiatives in their states,” said Susan Misiorski, PHI national director of training and organizational development services.

“There are currently 36 states with culture change coalitions, fueled largely by volunteers,” Misiorski added.

CMS describes culture change in the memo as “the national movement for the transformation of older adult services, based on person-directed values and practices where the voices of elders and those working with them are considered and respected. Core person-directed values are choice, dignity, respect, self-determination and purposeful living.”

The memorandum lists examples of culture change initiatives in several states, including:

• a culture change project that focuses on achieving staff stability in nursing homes in Louisiana;
• projects that facilitated implementation of culture change in New York State nursing homes; and
• the development of web-based training modules on culture change principles and practices for ombudsman staff and volunteers in Georgia.

Training Initiatives Approved

Training for facility improvement initiatives that are open to multiple nursing homes is also on the CMS list of categorically permitted uses of CMP funds.

One example provided in the memorandum is the joint training of surveyors and facility staff from multiple nursing homes committed to implementing effective fall-prevention programs.

Under the Affordable Care Act, a portion of collected federal CMP funds may be used to support activities that promote quality care and the well-being of nursing home residents in certified nursing homes.

– by Deane Beebe

The Centers for Medicare & Medicaid Services (CMS) has endorsed an adult abuse and neglect prevention training program designed for direct-care workers.

The 12-module curriculum — developed collaboratively by BEAM (Bringing Eden Alternative to Michigan), Michigan State University, and PHI with leadership from the Michigan Office of Services to the Aging -– is available as a free download at the PHI Training and Organizational Development Services website.

The adult learner-centered curriculum “includes highly interactive trainings that focus on actively building person-centeredness and self-management skills within individuals and organizations,” said PHI training and organizational development specialist Maureen Sheahan, who supported the curriculum design.

Kari Sederburg, director of the Michigan Office of Services to the Aging, added that the Michigan State evaluation of the training found that “almost every staff person who used the skills reported that it helped to prevent abuse or neglect.”

CMS’s endorsement came in an August 12 memorandum (pdf) to State Survey Agency directors recommending several training resources that deal with abuse prevention and dementia care.

Section 6121 of the Affordable Care Act mandates enhanced training on each of those subjects for nurse aides working in nursing homes.

– by Matthew Ozga

Three brief stories on direct care:

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CMS Proposes Guidelines for State Balancing Incentive Payments Program

The Centers for Medicare & Medicaid Services issued a “State Medicaid Directors Letter” (pdf) on September 12 to provide guidance for establishing the State Balancing Incentive Payments Program, a provision of the Affordable Care Act.

The new program, created to serve more people in home- and community-based settings, will assist states in “transforming their long-term care systems” by:

• improving systems performance and efficiency;
• creating tools to facilitate person-centered assessment and care-planning; and
• enhancing quality measurement and oversight.

The Balancing Incentive Program offers a targeted increase in the Federal Medical Assistance Percentages (FMAP) for non-institutional long-term services and supports (LTSS) to states that undertake structural reforms to increase access to home- and community-based LTSS.

On October 7, the Friday Morning Collaborative, a coalition of national aging and disability organizations, is hosting a webinar on the Balancing Incentive Payments Program. Registration is free, but space for the webinar is limited.

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State Direct-Care Worker Associations to Hold Annual Meetings

The Arizona Direct Care Worker Association (ADCWA) is holding its 4th Annual Conference and Celebration in Tucson on October 5 to honor and educate certified nursing assistants, home care workers, and professional caregivers in the state. To learn more about the event and register, visit the ADCWA website.

The Florida Professional Association of Care Givers is sponsoring its 16th Annual Caregivers Convention entitled, “Building a Quality Direct Care Workforce for Tomorrow’s Demands!” The all-day educational meeting will take place in Altamonte Springs on October 20. A registration form and more information is available at the association’s website.

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Des Moines Register Editorializes on Better Rewards for Caregivers

The Des Moines Register published an editorial in late August arguing that to ensure an adequate supply of direct-care workers to care for aging Iowans, those workers must have better wages, health coverage, education and training, and be valued in the medical field for the critical work they perform.

The editorial also explains that worker turnover is costly to employers, Medicaid, and consumers.

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PHI Newsletter Survey

If you have not done so already, please take a moment to give us your feedback on the PHI Quality Care, Quality Jobs newsletter by completing this anonymous survey. Thank you to all of the subscribers who already responded.

The CMS/National Direct Service Workforce Resource Center will unveil the PHI State Data Center at a webinar that will feature a discussion with PHI Director of Policy Research Dorie Seavey and other presenters on strategies that states can use to impact workforce size, wages and benefits:

September 19
3:00 PM – 4:30 PM EST
Call-in number: 800- 260-0702
Code: 213233
There is no charge for the webinar but registration is required.

In an April 26 letter to the Centers for Medicare and Medicaid Services (CMS), PHI filed its comments to the proposed rule (pdf) on the implementation of the Community First Choice Option (CFC).

PHI recommended that CMS recognize the impact of the direct-care workforce on the cost and quality of home- and community-based services (HCBS), as well as consumer access to those services, by incorporating specific direct-care workforce criteria in the draft rule.

The CFC program is an optional state Medicaid program created under the Affordable Care Act to provide individuals with disabilities who are eligible for nursing homes and other institutional settings with options to receive community-based services.

It also expands the definition of attendant care and allows for payment of other services, such as one month’s rent, if it helps the individual with their transition from an institution to the community.

Invest in Workforce Compensation

In a letter (pdf) to CMS Administrator Don Berwick, PHI Government Affairs Director Carol Regan raises concern that the proposed CFC rule does not explicitly recognize “the building of a far more stable and available home care workforce” as an “essential component” of efforts to expand home- and community-based services to a broader population.

Beginning in October 2011, states that choose to participate in the CFC will receive a 6 percent increase in federal Medicaid matching funds. PHI advises that “a portion of these funds should be invested in workforce compensation, an investment that has been shown to improve recruitment and retention and thus quality of care.”

Building a Workforce to Meet Program Goals

PHI recommends that CMS include provisions in the CFC regulations that will enable states to take on responsibility for building a consumer-directed workforce that is sufficient to meet the program goals, by:

• Ensuring adequate compensation for direct-care workers;
• Establishing consumer-workforce labor market intermediaries or registries;
• Implementing data systems to monitor the direct-care workforce; and
• Including workers and their representatives on the Development and Implementation Councils.

PHI’s comments include the growing body of evidence about how the lack of available direct-care workers is already limiting access to HCBS; how poor compensation is a leading barrier to recruitment, retention, and quality; and how policy steps are needed to fill our nation’s “care gap.”

PHI’s comments (pdf) on the proposed rule for the implementation of CFC are available on the PHI PolicyWorks site.

– by Deane Beebe

Fifteen states have received federal contracts from the Centers for Medicare and Medicaid Services (CMS) to design new ways of providing coordinated care for individuals receiving both Medicaid and Medicare benefits, also known as “dual eligibles.”

The chosen states will receive up to $1 million each, which they will use to develop creative, person-centered strategies that will promote simplified care models for “dual eligible” individuals.

The project’s funding stems from a provision in the Affordable Care Act.

Costly and Complicated Care

Of the approximately 100 million individuals enrolled in Medicare and Medicaid, nine million are dual eligible (pdf).

Providing and coordinating care for those nine million beneficiaries can be complicated and costly.

According to CMS, for example, dual eligibles account for 27 percent of Medicare spending and 39 percent of Medicaid spending each year — percentages that far exceed their proportional representation within those two programs.

In addition, the care infrastructure for dual-eligible individuals tends to be unnecessarily complex, according to CMS.

“The more than 9 million dual eligibles in the U.S. are more likely to have mental illness and/or multiple chronic disorders than recipients of either Medicaid or Medicare,” said Michigan Medicaid Director Stephen Fitton. “Yet because of their unique status, they tend to face the most complicated and uncoordinated care models of anyone in the U.S.”

Many dual eligibles have to contend with multiple sets of benefits; multiple providers, which may or may not coordinate their patients’ care; and several different identification cards — one each for Medicaid, Medicare and a prescription-drug benefit.

Simplifying Care for Dual Eligibles

The 15 states have been tasked with integrating and coordinating person-centered care for dual-eligible beneficiaries across multiple spectrums: primary, acute, behavioral, and long-term care.

Michigan, for example, has received $1 million to help make its Medicaid and Medicare infrastructures more complementary for dual eligibles. Representatives from PHI Michigan will help advise that state on constructing its proposal.

“Integrating care for those who are eligible for both Medicaid and Medicare really is a win-win for our state,” Michigan Governor Rick Snyder told Crain’s Detroit Business.

“Vulnerable recipients will benefit through better coordinated and higher quality care, and Michigan taxpayers will benefit by ensuring resources are spent wisely.”

Presenting Proposals

States will present their proposals to CMS’s Federal Coordinated Health Care Office, also known as the Duals Office. The Duals Office was established in December as part of the Affordable Care Act.

The Duals Office will work with the 15 states to flesh out their most promising proposals.

In addition to Michigan, the states chosen for the contracts are California, Colorado, Connecticut, Massachusetts, Minnesota, New York, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington State, and Wisconsin.

– by Matthew Ozga