Claire Curry
Last week, The Community Partnership submitted comments Center for Medicare & Medicaid Services’ (CMS) proposed rule related to civil money penalties for nursing homes under the Medicare and Medicaid programs. We are excited to be able to participate and share our views with the federal agencies as the new health reform law begins to take shape. Proposed regulations which are put out for comment will shape policies for years to come. Our Partnership has been very active in Virginia working to see that our Civil Monetary Penalty funds are used for quality improvement initiatives. Right now, the very exciting Virginia Gold CNA Retention Project which the Partnership is doing with one local nursing home is funded through CMP money. Without the voices of consumer and direct care worker advocates speaking out, that CMP money might have been diverted to less effective use. In our local Virginia gold project, DCA Board Member Angel Saylor and other direct care workers on staff at that facility are making great progress on the issues of CNA empowerment, creation of a more supportive work environment, enhanced opportunities for advancement, leadership, skills training, and peer mentorship. It is a terrific win-win situation when direct care workers receive more rewards, recognition and opportunities (bringing down the CNA turnover rate) and residents enjoy consistent and improved quality of care.
A copy of our comments are below:
August 10, 2010
Dr. Donald Berwick
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-2435-P
P.O. Box 8012
Baltimore, MD 21244-8012
RE: CMS-2435-P
Dear Dr. Berwick:
We appreciate the opportunity to comment on the Center for Medicare & Medicaid Services’ (CMS) proposed rule 42 CFR Part 488 related to civil money penalties for nursing homes under the Medicare and Medicaid programs. We applaud Congress and the Administration’s focus on promoting nursing home quality of care.
I am the Chair of the Community Partnership for Improved Long Term Care, an initiative of the Legal Aid Justice Center, which brings together individual volunteers and organizations in Central Virginia to work for improved nursing home conditions for all who live and work in these facilities. Thank you for your consideration of the following brief comments on the proposed rule:
1. Re: IIDR. Section 488.431. We strongly support the requirement for notification to an involved resident or resident representative, as well as state ombudsman, to provide opportunity for written comment in the IIDR process. This portion of the proposed regulation would be greatly improved by extending the opportunity beyond mere written comment, to include face-to-face participation at the option of the resident, resident’s representative, or ombudsman. It is critical to the improvement of nursing home care that the consumers be included in the IIDR process, and that they have the opportunity to challenge or support survey findings.
2. Re: CMP money; Uses and Approval, Section 488.433. This proposed regulation would have an even more powerful quality improvement impact if the federal portion of civil money penalty funds that are directed to CMS were increased from 50% to 90%. We believe this division of funds more accurately reflects the focus and importance given to improving the health and well being of nursing home residents by Congress and the Administration, which is reflected in the Affordable Care Act.
We strongly support the provision which requires that these CMP funds be used ENTIRELY for activities that protect or improve the quality of care for residents, and that the activities must be approved by CMS. The proposed regulation correctly identifies support of resident and family councils and other consumer involvement in assuring quality care as appropriate uses of CMP funds. Support for family and resident councils and for nursing home consumer advocacy groups is key to achieving quality of care. CMS should resist any pressures to allow other uses of CMP funds, such as facility surveys or other self promotional activities.
3. The examples of appropriate uses for CMP money, at Section 483.433(d), includes facility improvement initiatives approved by CMS. One critical area of facility improvement which the CMP funds could well be used to address involves direct care workforce issues and nursing home staff turnover. With the coming tsunami of aging persons who will need nursing home care, an adequate workforce of well-trained and fairly compensated direct care workers is indispensible to our nation’s long-term care system. The current low wages, lack of comprehensive benefits, low job status, insufficient training and lack of professional development opportunities, (especially for the front-line certified nursing assistants who perform the vast majority of hands-on care), all contribute to a plague of high turnover rates in nursing homes which compromises the quality of care. CMS should approve the use of CMP funds for activities designed to address these workforce issues, including quality improvement initiatives proposed by facilities themselves and by advocacy groups working to improve the quality of care by improving the quality of jobs for the direct care worker.
4. We urge the Agency to prioritize culture change transformation in long term care settings as a successful quality improvement tool. In the Affordable Care Act and in other places, Congress and the Administration have signaled strong support of culture change in long term care. For example, Section 6114 of the Affordable Care Act includes a pilot project to develop best practices for nursing homes that are involved in the culture change movement. Section 6114 includes language concerning development of funding streams for culture change. Civil money penalty funds would be ideal for fulfilling this portion of the legislative mandate. Directing additional funds to CMS to promote evidence-based culture change initiatives is consistent with Congress and the Administration’s position, and will help to transform long term care, to spur real improvements in quality and outcomes for residents, and to improve the workplace environment for nursing home staff which could improve retention rates.
Again, we thank you for the opportunity to comment on the proposed notice. We would be pleased to discuss any of these comments further, and to share our experiences and insights as you move forward with the implementation of the Health Reform Law. Please do not hesitate to contact us, and thank you again for your attention to these comments.
Sincerely,
Claire E. Curry, Esq.
Chair, the Community Partnership for Improved Long-Term Care
