Critical Access Hospitals (CAHs) have long played an important role in the provision of Skilled Nursing Facilities (SNF), swing bed, and other long term care (LTC) in rural communities and are more likely than other rural and urban hospitals to offer these services. The implementation of the Medicare SNF prospective payment system (PPS) in 1998 and subsequent exemption of CAH-based swing bed services from the SNF PPS in July, 2002 created financial incentives from CAHs to close their SNF units in favor of providing skilled level care using swing beds. During the period 2004 through 2007, 42 CAHs closed their SNF units. Despite the changing financial incentives related to the operation of SNF units by CAHs, 42% of CAHs (456) in 2010 continued to operate SNF units. Little is known about the reasons CAHs decide to close or retain their LTC services. This briefing paper and associated policy brief address this gap by examining the factors related to operation of skilled nursing services by CAHs, and specifically the factors related to closure of skilled nursing units by some CAHs and the continued provision of these services by others.
Critical Access Hospitals (CAHs) that closed Skilled Nursing Facility (SNF) units cited a range of financial challenges related to payer mix, operating costs, cost allocation methods, and service utilization patterns.
The availability of alternative local long term care services, including swing beds, often contributed to hospitals’ decisions to close their SNF units.
CAHs that continued to operate SNF units were driven primarily by community need, despite the financial disincentive for doing so.
Hospitals reported substantial variation in their strategies for using swing beds for SNF, rehabilitation, and post-acute services.
Given ongoing concerns about financial viability and low census rates among some CAHs, further research on the ability of CAHs to expand patient services and revenues through swing bed use is warranted.
Additional research on the quality and outcomes of skilled care delivered by CAHs in SNF and swing beds is also recommended.
This report, authored by USM Muskie School research staff, presents the results of the 16 CHIPRA Core Measures that were collected using MaineCare claims or Vital Statistics data and reported in the State of Maine’s FFY 2012 CHIP Annual Report to the Centers for Medicare and Medicaid Services (CMS). Also included in this report are an additional three measures from the Improving Health Outcomes for Children (IHOC) project’s Master List of Pediatric Measures. In addition to presenting results in graphs and narrative, this report also provides measure definitions and background information about each measure topic.
The goal of this document is to present the claims- and vital statistics-based CHIPRA and IHOC measure results in a user-friendly format for IHOC project stakeholders. Measures are grouped by topic. For each topic, a Background section provides a brief description and rationale for collection. (The background discussion for CHIPRA Core Measures is drawn from the Background Report for the Initial, Recommended Core Set of Children’s Healthcare Quality Measures for Voluntary Use by Medicaid and CHIP Programs. Available at: http://www.ahrq.gov/chipra/corebackgrnd.htm) Next, we provide a general description of how each measure is defined, followed by the results.
This report, co-authored by Kimberley Fox and Carolyn Gray, provides a final evaluation of the initial phase of First STEPS (Strengthening Together Early Preventive Services), a learning collaborative led by Maine Quality Counts to support 24 pediatric and family practices in improving their childhood immunization rates. The evaluation found that all participating practices had higher immunization rates after participating in First STEPS. On average, overall child immunization rates increased by 5.1% at 12 months and 7.1% at 15 months, and average immunization rates across practices increased significantly from 74.2% to 81.3%. Practices also reported significant improvement in the use of recommended office practices, including staff training, recall/reminder procedures, and the use of data/registries.
This work was conducted under a Cooperative Agreement between the Maine Department of Health and Human Services and the Muskie School of Public Service at the University of Southern Maine and is funded under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) authorized by Section 401(d) of the Child Health Insurance Program Reauthorization Act (CHIPRA). These contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.
Suggested citation:Fox K, Gray C. Improving Health Outcomes for Children (IHOC) First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents. (Final Evaluation Report). Portland, ME: University fof Southern Maine, Muskie School of Public Service; March 2013.
The Muskie School of Public Service hosted two health policy colloquia this April to promote informed discussion throughout the state regarding MaineCare coverage options under the ACA and the implications of Vermont’s move toward a single-payer system.The series, sponsored by the Muskie School Board of Visitors, offers community conversations in which experts from various disciplines and perspectives inform and engage the broader public to explore and debate critical policy issues. On April 22, community and sector leaders joined for Global Budgets, Payment Reform, and Single Payer: Understanding Vermont's Health Reform. Participants discussed Vermont's recent movie toward single payer health care and how the state is cutting costs and improving how health care is delivered, as well as the implications for Maine.
Anya Rader Wallack, chair of the Green Mountain Care Board, presented on ways in which the state is seeking to make heath care a public good, creating an integrated delivery system, and moving to a single system where access to health coverage is not linked to employment.
Read the brief authored by Trish Riley of the USM Muskie School.
A study of collaboration among the child welfare, early intervention and preschool special education, and early care and education systems to promote the school readiness of children in the child welfare system, based on an analysis of data from the National Survey of Child and Adolescent Wellbeing (NSCAW) and a case study in Colorado that included key stakeholder interviews and foster parent and caseworker surveys.
This Chartbook is an update to the Chartbook: Older Adults and Adults with Physical Disabilities: Population and Service Use Trends in Maine 2010. With the aging of Maine’s population and its status as the “oldest” state in the nation, the use of long term services continues to be a critical public policy issue in the State and nationally. The information in this Chartbook is provided to help inform state policy makers, legislators, providers, advocates and others with an interest in this subject.
Outline of the Chartbook:
Sections 1-4 of this Chartbook provide general demographic information on historical and projected change in the population of older adults in Maine, by county and compared with other states. These sections also provide an overview of the number of older adults who live in poverty, have a disability and live in rural areas.
Sections 5 and 6 provide comparisons of the characteristics of people who live in nursing facilities, residential care facilities and at home.
Sections 7-10 examine the trends in the use and “case mix” of people in nursing facilities and residential care facilities.
Section 11 provides an overview of the supply of nursing and residential care facilities and beds.
Section 12 includes a summary of selected quality indicators across long term care settings.
Section 13 provides a comparison of the use of services across long term care settings and
Section 14 provides comparative expenditure data.
When referencing or using any of the charts or other materials in the Chartbook, please use the following recommended citation:
This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services. This first report provides a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008-2010. This report provides baseline data on the characteristics of Medicare-MaineCare members who are dually eligible, the distribution of expenditures across categories of service for MaineCare and Medicare, and the cost of care for people with select chronic conditions. The report includes information on members considered full benefit as well as those who are partial benefit members. Partial benefit members are also know as Qualified Medicare Beneficiaries, Specified Low Income Medicare Beneficiaries; Qualified Individuals; and Qualified Disabled and Working Individuals. Individuals who are dually eligible for MaineCare and Medicare typically have multiple chronic conditions, high medical and long term care costs, and low income. Medicare covers hospital, medical, skilled long term care and pharmacy services while Medicaid pays for behavioral health, community based long term services and supports and nursing home services. The integration of services and benefits for people who are dually eligible is a challenge for states and the federal government. As states move to introduce value based purchasing initiatives through health homes, accountable care communities and other managed care efforts, the need to coordinate services and align incentives between the Medicaid and Medicare programs becomes increasingly critical. Many states are involved in dual eligible demonstrations to improve the integration of services, benefits and care.
Suggested Citation: McGuire C, Gressani T, Bratesman S, Fralich J, Griffin E. Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. (Chartbook). Portland, ME: University of Southern Maine, Muskie School of Public Service; October 2012.
Over the last five years, options counseling has evolved from a general set of activities and functions within Area Agencies on Aging and Aging & Disability Resource Centers (AAAs/ADRCs) to a more standardized and generally accepted role within the Aging Network. With the award of the Community Living Program (CLP) grant in 2009, Maine proposed to develop more consistent methods for identifying people at risk of residential facility placement and to begin to develop standards for the options counseling functions. In 2010, Maine was also awarded an Options Counseling Standards Grant which has provided support for furthering the work started under the CLP grant.
Muskie School staff developed a Consumer Satisfaction Survey, A Survey of Options Counselors and Options Counselor Manager/Supervisor Survey. Results of the surveys and data from the follow-up form developed by the Steering Committee are included in the Outcomes section of this report. Muskie staff also conducted the evaluation of Maine's Options Counseling Standards Grant. The results of this evaluation are organized into two main sections: Implementation of Options Counseling which examines the processes, protocols and practices that were developed , and Outcomes which examines the implementation of the options counseling services along four dimensions:
Organizational Outcomes; and
Fralich J, Richards M, Olsen L. Maine's Community Living Program: Implementation and Outcomes. Portland, ME: University of Southern Maine, Muskie School of Public Service; December 2011.
To better understand the nature of the residential facilities serving more than 19 percent of Maine’s Long Term Services and Supports (LTSS) population, the Maine Department of Health and Human Services commissioned the Muskie School to conduct a survey of residential facilities as part of its update to Maine’s LTSS profile. The goal of the Maine Residential Settings Characteristics Survey, conducted between July and September 2010, was to measure the "homelike" characteristics of residential settings.
The survey sample comprised a total of 636 facilities which included all licensed residential care facilities or private non-medical licensed institutions. The survey response rate was 82.9%, and survey questions collected information about the facilities' physical characteristics and features, services, resident characteristics, and policies relating to autonomy and privacy.
Fralich J, McGuire C, Griffin E. "Homelike" Characteristics of Maine's Residential Services: A Survey of Maine's Residential Service Settings (2010). (Chartbook). Portland, ME: University of Southern Maine, Muskie School of Public Service; November 2012.
The primary goal of Maine’s Aging and Disability Resource Center (ADRC) Project was to empower consumers to make informed decisions about long-term services and supports and to streamline access to existing services and supports through an integrated system. With funding from the Administration on Aging to strengthen and expand the number of Aging and Disability Resource Centers (ADRCs) in the state, all five of the Area Agencies on Aging were committed to becoming and/or strengthening their capacity to be fully functioning ADRCs.
This report provides a summary of the results of consumer satisfaction surveys that were conducted for three years at all five ADRCs. The survey was designed to capture the consumer view of the ADRC services in key domain areas including: visibility/trust; efficiency; responsiveness and effectiveness. Also included is a summary of consumer comments that were shared by those responding to the survey and a summary of lessons learned from the administrators at the ADRCs. Significant accomplishments of the ADRCs were reported as training; providing information, resources, navigation assistance and options counseling to a broad spectrum of aging and disabled adults, along with their caregivers; the ability to expand the ARDC's role into the disability community; and the connection with community providers. Challenges reported included the lack of resources and inability of the State Unit on Aging to be approved to apply for future funding; ongoing operations and expansion as a a fully functioning ADRC without the funding to support the additional work, and the need for updated on-line referral database and the staffing to maintain it.
Fralich J, Olsen L, Richards M, Bowe, T. Satisfaction Survey Results and Lessons Learned: Maine's Aging & Disability Resource Center (ADRC) Project. Portland, ME: University of Southern Maine, Muskie School of Public Service; December 2012.