Tennessee Civil Monetary Penalty (CMP) Reinvestment

Program

Workshop Objectives

• Understand the current nursing home quality landscape in Tennessee

• Brainstorm community partnerships that can aid in

supporting nursing homes in rural communities

• Gain understanding of the Civil Monetary Penalty process & program

Tennessee’s Current Landscape

Key Stats

• The number of Tennessee seniors age 65+ is expected to double from 850,000 in 2010 to 1.7 million in 2030

• Tennessee ranked 37th for nursing home quality according to America Health Rankings’ 2017 Senior Report

• Nursing home residents in rural areas may suffer from complex medical problems such as obesity, hypertension, dementia, high blood pressure, and behavioral/psychiatric disorders

• Workforce issues faced by rural LTC facilities include transportation limitations, lack of opportunities for training and continuing education, and chronic provider shortages

• Over 26,000 residents

• 316 Medicare and/or Medicaid facilities

Alzheimer’s/Dementia Prevalence

Nursing Home Quality Measures

• CMS Five Star Rating – Health Inspections – Staffing – Quality Measures

• F-Tags

– Scope and Severity: J, K, and L constitutes as Immediate Jeopardy to resident health or safety

Top Ten Deficiencies in Tennessee

Tag # Tag Description # Citations % Providers

Cited % Surveys

Cited

Totals represent the # of providers and surveys that meet the selection criteria specified above.

Tennessee Active Providers = 318

Total Number of Surveys = 1271

K0353 Sprinkler System - Maintenance and Testing 118 33.60% 9.30% F0880 Infection Prevention & Control 83 24.80% 6.50%

F0812 Food Procurement, Store/Prepare/Serve Sanitary 65 20.40% 5.10%

F0689 Free of Accident Hazards/Supervision/Devices 55 15.40% 4.30% F0609 Reporting of Alleged Violations 53 11.00% 4.20% K0321 Hazardous Areas - Enclosure 50 15.70% 3.90%

F0656 Develop/Implement Comprehensive Care Plan 48 13.50% 3.80%

K0920 Electrical Equipment - Power Cords and Extens 47 14.50% 3.70%

F0761 Label/Store Drugs and Biologicals 47 14.50% 3.70%

E0024 Policies/Procedures-Volunteers and staffing 40 12.60% 3.10%

Fast Facts: Tennessee Nursing Facilities

1, 2, and 3 Star Facilities Across Tennessee

40 one-star facilities, 55 two-star facilities, and 65 three-star facilities

Why Nursing Home Quality is a Community Issue

• Hospitals are held accountable for 30-day readmission rates, and 20-25% of those discharged go to a nursing home facility.

• Increased resident access to and participation in community life benefits overall health outcomes.

• Thousands of jobs statewide are dedicated to skilled nursing care.

• Nursing home residents are often isolated and have no one to advocate for their individual rights.

Nursing Home & TN Hospitals

Red: 1, 2 or 3 star nursing home Navy: Acute care or critical access hospital

TN Nursing Homes: Rural vs. Urban

14.2

9%

17.4

4%

21.4

3%

20.9

3%

17.8

6%

22.0

9%

17.8

6%

22.0

9%

25.0

0%

17.4

4%

0.00%

10.00%

20.00%

30.00%

Rural Urban

Overall 5-Star Rating Average

One-Star

Two-Star

Three-Star

Four-Star

Five-Star

TN Nursing Homes: Rural vs. Urban (cont.)

10.7

1%

10.4

7%

17.8

6%

9.30

%

53.5

7%

4.30

% 14

.28%

27.9

0%

0.00

% 8.14

%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Rural Urban

Staffing Rating

One-Star

Two-Star

Three-Star

Four-Star

Five-Star

TN Nursing Homes: Rural vs. Urban (cont.)

14.2

8%

29.0

7%

25.0

0%

25.5

8%

21.4

3%

20.9

3%

14.2

9%

16.2

7%

16.2

7%

8.14

%

0.00%

10.00%

20.00%

30.00%

40.00%

Rural Urban

Health Inspections

One-Star

Two-Star

Three-Star

Four-Star

Five-Star

TN Nursing Homes: Rural vs. Urban (cont.)

10.7

1%

2.33

% 10

.71%

8.14

%

21.4

3%

15.1

2%

14.2

9%

30.2

3%

21.4

3%

44.1

9%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Rural Urban

Quality Measures

One-Star

Two-Star

Three-Star

Four-Star

Five-Star

Opportunities to Collaborate

Healthcare Law Enforcement

Faith-based Groups Government

Local Businesses Universities & Schools

First Responders / Fire Dept.

Non-profits

Imagining Projects in Rural Areas

• Telemedicine

• Oral Health

• Staff Recruitment & Retention

• Mental/Behavioral Health

• Rural Emergency Preparedness

• Substance Abuse (Alcohol, Tobacco and Illicit Drugs)

CMP Reinvestment Program & Funding

Opportunity

Civil Monetary Penalty (CMP)

Tennessee CMP Funding:

$30,000,000.00

CMP Reinvestment Program

• Section 1919(h)(2)(A)(ii) of Social Security Act – CMP funds collected by state

must be applied to the protection of the health or prosperity of residents of nursing facilities.

• S&C-02-42 – Provides initial guidance to

states for appropriate use of funds.

• Tennessee reinvests funding through a grant process

Building Partnerships Data Sharing & Mapping Special Topics Webinars Long-term Care Updates Grant Writing

Rules & Regulations Program Services

Regulations available online Visit the CMP Website for more information

about Focus Areas

Focus Areas

• Healthcare associated infections

• Emergency preparedness

• Preventable hospitalizations

• CMS star rating

• Residents’ Rights

– Dementia/Alzheimer’s

– Elder abuse/neglect

Eligible Applicants

• Organizations include, but are not limited to:

– Certified long-term care facilities

– Hospitals and/or hospital systems

– Colleges and universities

– Community coalitions

– Resident or family councils

– Professional or state nursing home associations

– Consumer advocacy organizations

– Private contractors

– State survey agencies

Approved Uses of CMP Funds

• Projects that support quality care in facilities

• Staff training and development to support quality

improvement initiatives and performance improvement

• Time-limited expenses to a facility to relocate patients due

to another facility closing or downsizing

• Support for residents that must be relocated due to facility

closing or decertified

Current Tennessee Projects

Prohibited Use of CMP Funds

• Supplementary funding of federally required services

• Projects greater than three years

• Projects for which a conflict of interest exists

• Items or services not related to improving quality of life or

quality of care of patients

• Services or supplies that are the responsibility of nursing

homes (laundry, food, staffing costs, etc.)

• Capital expenses for a facility

Application & Review Process

Contact Us

Chelsea Ridley, MPH Director, TN Civil Monetary Penalty Reinvestment Program Chelsea.Ridley@tn.gov 615-532-8198

Jacy Weems Asst. Director, TN Civil Monetary Penalty Reinvestment Program Jacy.Weems@tn.gov 615-770-6805

Website: https://www.tn.gov/health/health-program-areas/nursing-home-civil-monetary-penalty--cmp--quality-improvement-program.html