PROGRAM MANAGEMENT security risks and provide timely and accurate information for management purposes. With the unified system, CMS and the rest of the Department will have uniform business rules; data standards and accounting policies and procedures for a more efficient implementation as administrative support functions are incorporated. HIPAA Administrative Simplification ($2.7 million) The Secretary has given CMS a national leadership role in implementing HIPAA's administrative simplification Electronic Data Interchange provisions. CMS costs include: developing the standards for industry use; implementing the transaction standards, as well as new versions and additional standards, and offering technical assistance to Medicare contractors, managed care plans, and Medicaid State agencies; doing provider outreach; and conducting testing with the Medicare providers. CMS systems (such as the National Medicare Utilization Database and capitation payments to managed care plans) will also require revisions. Implementation of Recent Legislation and New Activities We have included funds in our FY 2003 Federal Administration request, above, to Balanced Budget Act Funding at a $5.5 million level will support our Nursing Home Oversight Improvement Program Funding at a $4.8 million level will primarily support FTEs required to oversee State activities, to provide additional assistance to State inspectors in nursing homes and to respond to provider and consumer inquiries. Our request provides funds required for onsite visits to ensure State surveyors are in compliance with the Federal survey process and contractual agreements. New Freedom Initiative Ticket to This initiative will be funded at a $0.85 million level to promote integration of promote Supreme Court decision. PROGRAM MANAGEMENT State Children's Health Insurance Program Funding at a $1.9 million level will support the continuation of the SCHIP administration for the national outreach program, targeted assistance, travel, and printing. In order to effectively and efficiently run this program, personnel are needed to: review and approve State plans and amendments, monitor and evaluate the program to ensure compliance with Title XXI, receive and analyze SCHIP quarterly and annual financial reports, compile statistical information and develop program guidance. APPROPRIATIONS HISTORY: The table below displays Federal Administration funding levels for the past five years. PROGRAM MANAGEMENT Medicare Survey and Certification Program Medicare Survey and Certification Summary Table CMS's FY 2003 budget request for Medicare Survey and Certification is $247,647,000, 2.3 percent above the FY 2002 President's Budget request, but a decrease of $6.8 million or 2.7 percent below the FY 2002 enacted level. This includes funding for surveys and the associated State costs, and contracts to support the program. We project that Medicare and Medicaid will pay 55 percent of all nursing home expenditures in FY 2003. Therefore, the Federal government has a responsibility to ensure that its expenditures are prudent and to protect the health and well being of one of the Nation's most vulnerable populations. In order to secure quality care for the elderly, CMS requires that all facilities seeking participation in Medicare and Medicaid undergo an inspection when they initially enter the program and on a regular basis thereafter. This includes long-term care facilities, home health agencies, hospitals, and other non-long-term care facilities. CMS contracts with 51 State survey agencies to inspect providers and determine their compliance with specific Federal health, safety, and quality standards. There are a total of approximately 6,000 State surveyors. Staff from CMS's Central and Regional Offices provide training to State surveyors and monitor the consistency and quality of State surveys. PROGRAM MANAGEMENT Unfortunately, in 2000, 87 percent of nursing home facilities were cited for health deficiencies. The average number of deficiencies per facility was approximately 6 in 2000. La the same year, 25 percent of nursing home surveys resulted in a health deficiency of actual harm or immediate jeopardy to nursing home residents. These data demonstrate the profound importance of regular, comprehensive inspections of health care facilities. From FY 1992 to FY 2001, the number of total facilities participating in Medicare and Medicaid grew by 66 percent from just over 26,900 to approximately 44,700. Despite this growth in the number of facilities and the number of initial, recertification, and complaint surveys necessary, the Medicare Survey and Certification budget was relatively flat from FY 1992 to FY 1998. In FY 1992, the Survey and Certification budget was $149.4 million; in FY 1998, it was $154 million. This eventually led to concerns that the budget was not keeping pace with program needs and was putting beneficiaries in potential danger. Therefore, the subsequent four years included substantial increases to the budget. This request explains the funding necessary to administer the Medicare survey and certification program in FY 2003. The costs to administer Medicaid survey and certification activities are shown in the Medicaid chapter of this justification. The FY 2003 Medicare survey and certification program request of $247.6 million is separated into two main categories: direct surveys and support contracts. The majority of the budget request, 92 percent, is allocated to direct survey costs. The remaining 8 percent is for support contracts. The pie chart on the following page breaks down the program request into further detail to show direct survey costs for long-term care and non-long-term care facilities, the Nursing Home Oversight Improvement Program (NHOIP), other direct survey costs, and support contracts. Direct survey costs represent the funding given directly to the States to perform surveys and complaint visits, and to support the associated program costs. As shown below, the direct survey budget includes resources to survey all provider types, with the majority of the request funding long-term care facility surveys. |