SURVEY AND CERTIFICATION Reduction of facility-acquired pressure sores remains a high priority of the agency. There are a number of ongoing and planned initiatives that we think will lead to surveyors' improved identification of facility quality of care problems and that will help facilities improve their own quality of care. The CMS is developing a program to educate providers about more accurate assessment and coding of residents' conditions. including pressure ulcers. The CMS is also developing protocols, including onsite audit procedures, to assess the accuracy of nursing homes' Minimum Data Set (MDS) assessments. The CMS will continue to evaluate these data to determine whether or not they represent a true increase. For example, the CMS has developed a measure to track facility-acquired pressure ulcers to help differentiate pressure ulcers that develop in other care settings from those that develop in the nursing home. Additionally, CMS has convened a panel of national clinical experts in pressure sore treatment and prevention. These experts have helped CMS revise the interpretive guidelines and investigative protocols used by surveyors and to improve surveyor training. Coordination: The CMS is actively pursuing participation of nationally recognized clinical experts on pressure ulcer care in our guideline development. The CMS is working with provider organizations, States, and consumer advocates in developing survey instruments and guidelines. In addition, as part of our effort to develop consistent scope and severity guidance, we have invited nationally recognized pressure ulcer experts from Yale University, and from the National Pressure Ulcer Advisory Panel to help us address pressure ulcer issues. Data Source(s): The CMS will use the MDS, including special reports derived from the database, such as the quality indicator reports; to measure prevalence of pressure ulcers in long term care facilities. This information is submitted to the State MDS database and in turn is captured in the national MDS database. The measure being used for the pressure ulcer goal is one developed by the Center for Health Systems Research and Analysis at the University of Wisconsin, Madison (CHSRA) that is derived from MDS assessments. For this goal we report the prevalence of pressure ulcers measured in the last six months of the fiscal year. If the year is not complete, we report the most recent data available. The numerator consists of all residents with a pressure ulcer, stages 1-4 on the most recent assessment and the denominator is all residents. Pressure ulcers counted on admission assessments are excluded. Verification and Validation: MDS data quality assurance currently consists of reviews by surveyors and by CMS contractors to ensure that MDS assessments are reported in a timely and complete manner. In addition, CMS is developing protocols to validate the accuracy of individual MDS items and will continue to provide training to providers on accurate completion of the MDS. SURVEY AND CERTIFICATION Performance Goal QSC3-04 Improve the Management of the Survey and Certification Budget Baseline: Allocate funding based on previous year's costs. FY 2004 Target: Allocate FY 2004 State Survey and Certification budget using the price-based budget methodology to distribute, at a minimum, any budget increases to those States that do not exceed 15 percent above the combined national average hours for long term care and/or non long term care surveys. Use performance measures and associated baselines to measure the quality of the survey work performed. FY 2003 Target: Allocate FY 2003 State Survey and Certification budget using the price-based budget methodology to distribute, at a minimum, any budget increases to those States that do not exceed 15 percent above the combined national average hours for long term care and/or non long term care surveys. Use performance measures and associated baselines to measure the quality of the survey work performed. FY 2002 Target: Allocate the FY 2002 State Survey and Certification budget using the price-based budget methodology to distribute, at a minimum, any budget increases to those States that do not exceed 15 percent above the combined national average hours for long term care surveys. Use performance measures and associated baselines to measure the quality of the survey work performed. Performance: FY 2002 Target met for allocating FY 2002 Survey and Certification budget. The CMS finalized its FY 2002 performance standards for State survey agencies. FY 2001 Target: Begin moving States towards a price-based methodology by allocating budget increases to those States with unit survey hours that do not exceed 15 percent above the combined national average, for long term care surveys. Allocate FY 2001 budget increases to those States that are within the 15 percent threshold, as appropriate. Develop performance measures and associated baselines that can be used to measure the quality of the survey work performed. Performance: FY 2001 Target met for allocating FY 2001 Survey and Certification budget. Discussion: The CMS's primary mission with the survey and certification program is to ensure that the nation's elderly and disabled are receiving high quality care. In order to ensure this high level of care, CMS has a responsibility to purchase high value survey services, verify that the survey services were performed as contracted, and assess the quality of the survey services performed. To accomplish these objectives, CMS moved from a cost-based budget development and execution model to a price-based model. A price-based methodology for developing and allocating survey and certification funding uses national standard measures of workload and costs to project individual State workloads and budgets, in order to move States towards more uniformity and efficiency. To accomplish these objectives and to help ensure national consistency in the survey and certification budget process, CMS will continue to review and analyze State reported OSCAR 670 data in the area of survey hours reported for long term care facilities. For example, in FY 2002 CMS assumed the FY 2001 State funding levels as the budget base for States. Any increase to a State's FY 2002 base budget was contingent upon CMS's analyses of combined national average survey times for long term care facilities (skilled nursing and dually participating nursing facilities). Specifically, States that were within SURVEY AND CERTIFICATION 15 percent or less of the combined national average survey time were provided with an FY 2002 base budget increase proportionate to each State's FY 2001 budget. Any State that exceeded the 15 percent combined average survey time threshold received a base budget that assumed the FY 2001 funding level. The CMS will continue to update historical data with State reported Online Survey and Certification and Reporting (OSCAR) data. By focusing on average survey hours as the cornerstone of a price-based methodology, CMS will use national standard measures of workload and costs to project State workloads and budgets for FY 2003. The CMS finalized its FY 2002 performance standards for State survey agencies. The Data Source(s): Workload data obtained from State reported OSCAR data and State levels. Verification and Validation: OSCA data are validated annually as part of annual onsite surveys. Form HCFA-434 and Form HCFA-435 data are validated through CMS Regional Office reviews. Medicaid is a means tested health care entitlement program financed by States and the Federal Government. Approximately 43 percent of the funding came from the States and 57 percent from the Federal Government in FY 2002. All 50 States, the District of Columbia, and the five territories (Puerto Rico, Virgin Islands, American Samoa, Northern Mariana Islands, and Guam) have elected to establish Medicaid programs within broad Federal guidelines governing eligibility, provider payment levels, and benefits. Medicaid programs vary widely from State to State. Another representative goal related to this budget category but not listed in the chart below is: Decrease the Number of Uninsured Children by Working with States to Implement |