PROGRAM MANAGEMENT In FY 2004, the direct survey cost estimate includes $25.0 million for Nursing Home Oversight Improvement Program direct survey costs. CMS continues to monitor the progress in areas targeted by the Nursing Home Oversight Improvement Program. CMS will continue activities already initiated to ensure that Medicare beneficiaries in nursing homes receive quality care in a safe environment. These include the following: investigating, processing, and reporting complaints which allege actual harm within 10 days ($10.1 million); imposing immediate sanctions for nursing homes found to have care deficiencies that involve actual patient harm on any survey ($6.3 million); developing a systematic, more comprehensive survey process to more effectively detect critical quality of care problems ($7.3 million); staggering inspection times to include a set amount begun on weekends and evenings ($0.6 million); and focusing surveys on two repeat offenders with serious violations per State ($0.7) million. גייד י, יון Performance Goal QSC2-04 - Decrease the Prevalence of Pressure Ulcers in Nursing 121 The FY 2004 direct survey cost estimate also includes $8.0 million for several continuing activities: Minimum Data Set (MDS) State program costs, including system maintenance and ongoing collection and housing of data used in the development and testing of program improvement projects ($4.0 million); Outcome and Assessment Information Set (OASIS) State program costs, including providing training to all home health agency providers on the OASIS, operating the system, running reports, and providing technical support ($3.0 million); and printing, transcripts, and travel costs ($1.0 million). PROGRAM MANAGEMENT SUPPORT CONTRACTS - $18.7 million Support contracts, managed internally by CMS, constitute $8.5 million of the FY 2004 request. Critical Survey and Certification support contracts include, but are not limited to, the following: surveyor training; logistical support services; maintenance and enhancement of the OSCAR data system; the Surveyor Minimum Qualifications Test (SMQT); as well as other efforts to ensure national program oversight and consistency. In addition to the internally managed support contracts, CMS also has NHOIP support contracts which total $10.2 million. A few activities that this funding level covers include comparative surveys for nursing homes, expert testimony, nursing home staffing data, contractor survey development, and the review of abuse prevention efforts. The total support contracts funding request for FY 2004 is $18.7 million. PROGRAM MANAGEMENT SUMMARY OF THE NURSING HOME OVERSIGHT IMPROVEMENT PROGRAM CMS's FY 2004 budget includes $92.4 million dedicated to the Nursing Home Oversight Improvement Program (NHOIP). CMS has made significant strides in the areas targeted by this program, and is committed to continuing to work with residents and their families, advocacy groups, providers, States, and Congress to ensure that residents receive the quality care and protection they deserve. This budget reflects CMS's continued commitment. As discussed below, there are several funding sources for this program. Please refer to the Medicare Survey and Certification Program section. FEDERAL ADMINISTRATION - $4.8 million As shown below, the NHOIP request includes Federal oversight activities and other associated costs. Federal Oversight - $3.4 million CMS will maintain 35 FTEs to continue the following activities: · Process sanction notices and respond to litigation and appeals; Provide additional training and other assistance to inspectors in States, ensure that proper Federal protocols are being followed, and enhance national uniformity of oversight in the protection of residents; PROGRAM MANAGEMENT Monitor and update information about abuse prevention efforts in nursing homes, and respond to provider and consumer inquiries; Develop State sanction options that may be imposed, including termination of Ensure that State surveyors enforce existing policy to sanction nursing homes with serious violations, and that sanctions cannot be lifted until after an onsite visit has verified compliance. Other - $1.4 million The Federal Administration account also includes funding for travel, contracts, supplies, printing, and equipment associated with the NHOIP. MANDATORY Medicaid State Survey Costs - $44.0 million State Medicaid programs will share in the direct survey costs and complaint visit costs associated with the NHOIP for dually certified nursing facilities and Medicaid only nursing homes. Quality Improvement Organization (QIO) Support Contracts - $8.45 million The QIO 7th Scope of Work includes $8.4 million in FY 2004 for support contracts supporting the NHOIP, which includes $4.0 million for Minimum Data Set (MDS), $1.8 million for Outcome and Assessment Information Set (OASIS) accuracy review contracts, $2.0 million for promotion, quality, and continuing research in nursing homes, $500,000 for website support for nursing home compare, and $150,000 for measurement refinement in nursing homes. גיוייד Performance Goal QSC1-04 - Decrease the Prevalence of Restraints in Nursing Homes PROGRAM MANAGEMENT Research, Demonstration and Evaluation Authorizing Legislation - Social Security Act, Sections 1110, 1115, 1875 and 1881(a); Social Security Amendments of 1967, Section 402; Social Security Amendments of 1972, Section 222. The FY 2004 estimate for funding CMS's Research, Demonstration and Evaluation (RD&E) activity is $63.4 million. The FY 2004 request reflects an increase of $35 million from the FY 2003 President's budget. The RD&E program supports CMS's key role as a beneficiarycentered purchaser of high-quality health care at a reasonable cost. RATIONALE FOR THE BUDGET REQUEST The FY 2004 RD&E budget will continue to support research and demonstrations directed at helping to chart the course for the future of our programs. CMS has participated actively in the Department's Research Coordination Council (RCC) to ensure that the agency's FY 2004 planned research, demonstration, and evaluation (RD&E) activities align with the President's and Secretary's priority areas; identify opportunities for increased collaboration with other DHHS Agencies; avoid overlapping areas of focus across agencies; and fill potential gaps in research efforts. For example, the RCC identified a need for increased CMS resources to support the production of Medicaid and Medicare databases to support DHHS research priorities, as well as a need to increase coordination of grant programs for minority researchers. The narrative and table below categorizes our proposed research based on the Department's research themes for FY 2004. ייד 2 יון 12' Performance Goal R1-04 - Assess the Relationship between CMS Research Investments |