Civil Monetary Penalty Quality Improvement Program: Strategic Plan

Programmatic Strategies

The Tennessee CMP Reinvestment Program developed a Strategic Plan that outlines the areas of program focus to guide the disbursement and use of CMP funds. The Strategic Plan spotlights the short-term goals, long-term goals, and focus areas listed below. 

Short Term Program Goals

• By the end of calendar year 2021, the Tennessee CMP Reinvestment Program will provide a collection of resources and trainings related to each focus area on the CMP Reinvestment website for stakeholder use.
• By the end of calendar year 2021, the Tennessee CMP Reinvestment program, in partnership with the Office of Health Care Facilities, will market CMP funds to address one of the following topics: infection control, residents’ rights, person-centered care, and trauma-informed care.
• By end of calendar year 2021, develop multifaceted marketing strategies to engage stakeholders, encourage effective proposals, and increase awareness of the CMP Reinvestment Program.
• By the end of calendar year 2021, host a Parade of Programs for stakeholders and community partners in order to highlight collaboration, encourage support of existing funded projects, increase the quality of proposals, and promote CMP funding opportunities.

• Increase the quality of proposals with a high likelihood of CMS approval by the year 2022 as measured by the number of proposals received, percent sent to CMS, and percent approved by CMS.
• Increase the annual amount of funding awarded per fiscal year to qualified applicants.

Focus Areas

The CMP Reinvestment Program follows a Quality Assurance Performance Improvement (QAPI) approach utilizing multiple clinical measures to target funding priorities. The program’s 2022 focus areas are as follows:

1. Healthcare-Associated Infections (HAI)

2. Staff Retention

3. Preventable Hospitalizations

4. Person-Centered Care and Trauma Informed Care  

5. Residents’ Rights

a. Elder Abuse, Neglect, and Exploitation

b. Alzheimer’s disease and other dementias

Funding focus areas were selected utilizing CMS and state priorities which impact the quality of care and quality of life of nursing home facility residents. Healthcare-associated infection (HAI) measures show how often patients in a particular facility contract infection during the course of their medical treatment. According to CMS, when following guidelines for safe care, these infections can often be prevented.  Improved staff retention will allow for the consistent assignment of nursing home staff, which is known to be a component of high-quality resident care. Projects that focus on decreasing the turnover rate of direct care staff, which in turn will improve resident care, could lead to an improvement in resident satisfaction. By utilizing CMP Reinvestment funds to implement initiatives to improve quality measures (falls, preventable hospitalizations, etc.), resident care and quality of life would also improve. More than 110,000 Tennesseans have Alzheimer's. Due to the growing number of individuals aged 65 and older diagnosed with Alzheimer's disease and related dementias, the Tennessee CMP Reinvestment Program and CMP Reinvestment Advisory Committee decided to include it as a funding focus area. Trauma survivors, including veterans, survivors of large-scale natural and human-caused disasters, Holocaust survivors and survivors of abuse, are among those who may be residents of long-term care facilities.  For these individuals, the utilization of trauma-informed approaches is an essential part of person-centered care projects. CMS Requirements for Long-term Care Facilities, 42 CFR § 483.10 – Residents rights: Residents’ Rights are guaranteed by the federal 1987 Nursing Home Reform Law. Elder abuse projects would strengthen facility staff knowledge and education to better identify, address and prevent elder abuse, neglect, and exploitation in the nursing home population, thereby improving both the quality of life and the quality of care of nursing home residents.