PROGRAM MANAGEMENT SUMMARY OF THE NURSING HOME CMS's FY 2003 budget includes $86.0 million dedicated to the Nursing Home committed to continue work with residents and areas targeted by this program. We are their families, advocacy groups, providers, States, and Congress to ensure that residents receive the quality care and protection they deserve. This budget reflects our continued commitment. As discussed below, there are several funding sources for the program. FY 2003 Estimate Please refer to the Medicare Survey and Certification Program section. FEDERAL ADMINISTRATION - $4.8 million (in millions) $35.7 $4.8 $40.5 $41.8 $3.7 $45.5 $86.0 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: II-44 Process sanction notices and respond to litigation and appeals. proper Federal protocols are being followed, and enhance national uniformity of Provide additional training and other assistance to inspectors in States, ensure that oversight in the protection of residents. and respond to provider and consumer inquiries. Monitor and update information about abuse prevention efforts in nursing homes, PROGRAM MANAGEMENT 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 - $41.8 million State Medicaid programs will share in the direct survey costs and complaint visit costs associated with the NHOIP for dually-certified nursing facilities. Medicaid typically shares these costs with CMS's Program Management account. Peer Review Organizations (PROs, soon to be Quality Improvement Organizations (QIOs)) Support Contracts - $3.7 million The PRO seventh scope of work includes $3.7 million in FY 2003 for support contracts supporting the NHOIP. Performance Goal QSC1-03 – Decrease the Prevalence of Restraints in Nursing Homes 80-949 D-25 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. Research, Demonstration and Evaluation Summary Table FY 2001 FY 2002 FY 2003 Increase Or Decrease -$88,801,000 Appropriation/B.A. $138,311,000 $117,201,000 $28,400,000 PURPOSE AND METHOD OF OPERATIONS The FY 2003 estimate for funding CMS's Research, Demonstration and Evaluation (RD&E) activity is $28.4 million. There are two reasons for this significant decline. First, $62.0 million in Congressional earmarks added to the FY 2002 appropriation are eliminated. Second, CMS is reducing its research budget by an additional $26.0 million to focus on higher mission priorities. The FY 2003 request reflects a decrease of $88.8 million from the FY 2002 appropriation. The RD&E program supports CMS's key role as a beneficiary-centered purchaser of high-quality health care at a reasonable The FY 2003 request for RD&E is consistent with HHS plans to streamline research through its Research Coordination Council (RCC). This forum will evaluate Department-wide research funding priorities to ensure that efficiencies are realized and research funding priorities are consistent with the Administration's priorities. Along with similar but uniquely mission focused health services research in AHRQ, components of the NIH and Policy Research in the Office of the Secretary, CMS's research estimate of $28,400,000 will finance the Administration's highest priorities for PROGRAM MANAGEMENT assessing reform options for Medicare and Medicaid, e.g., projects mandated by the Balanced Budget Act (BBA), the Balanced Budget Refinement Act (BBRA), and the Benefits Improvement and Protection Act (BIPA). In addition, our research investment will help the Medicaid program carry out the requirements of the Olmstead court decision and support research needed for other critical policy development initiatives. MANDATED RESEARCH INITIATIVES-$5.5 Million The Balanced Budget Act of 1997 (BBA) and the Balanced Budget Refinement Act of 1999 (BBRA) and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) mandate many demonstrations and evaluations, studies, reports to Congress and the implementation of several prospective payment systems. It is estimated that $5.5 million will be expended to carry out these RD&E mandates. The following table displays estimated spending for RD&E mandated by BBA, BBRA and BIPA: •Evaluation of PACE for Proprietary Providers Demonstration Balanced Budget Refinement Develop a per diem prospective payment system (PPS) for $1,000,000 PROGRAM MANAGEMENT MEDICARE CURRENT BENEFICIARY SURVEY-$12.4 Million CMS will continue to nonsor the Medicare Current Beneficiary Survey (MCBS). MCBS is the only comprehensive source of information on the health status, health care use and expenditures, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries. MCBS is a powerful tool for evaluating our programs as well as a key source of data for policy research on the Medicare population. NEW FREEDOM DEMONSTRATION-$6.0 Million In support of the New Freedom Initiative, CMS will initiate, together with a limited number of volunteer States, a national demonstration designed to address workforce shortages of community service direct care workers. The demonstration will test the extent to which workforce shortages and instabilities might be addressed through (a) better coordination with TANF and (b) the availability of vouchers for worker health insurance or for tuition/day care credits. Participating States would be expected to develop options for workers to purchase affordable group health coverage through the State health insurance system or similar organized insurance group. EVALUATING CMS PROGRAMS AND DEVELOPING NEW The RD&E budget will continue to support a limited number of other high-priority activities to provide information about the effectiveness of CMS's current programs or to develop and test new program options. These activities may include: •Developing and testing new payment and delivery approaches for Medicare's managed care and fee-for service programs. •Conducting analyses to support the development of Medicare reform proposals for Congressional consideration, including exploration of various competition models and development of policy alternatives for prescription drug coverage. •Evaluating selected aspects of the Medicare, Medicaid, and SCHIP programs to assess how well they meet the needs of specific groups of beneficiaries, States, providers and other customers. |