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Federal Resources

Centers for Medicare & Medicaid Services

Use of Civil Money Penalty (CMP) Funds by States and Reporting of CMP Funds Returned to the State
June 2009 Centers for Medicare & Medicaid Services Memorandum clarifying how CMPs may be directed and used by States, and sharing suggestions of innovative projects and activities that have already been undertaken with CMP funds in some States.

Revisions to Interpretive Guidance at Several Tags, as Part of Appendix PP, State Operations Manual (SOM), and Training Materials

Changes to Interpretive Guidelines resulting from public recommendations from the 2008 CMS/Pioneer Network Environment Symposium. Revisions have ground-breaking implications for resident choice, environment and quality of life.

CMS 2008 Report "Freedom from Unnecessary Physical Restraints: Two Decades of National Progress in Nursing Home Care."

Evaluates the efforts to reduce the use of physical restraints after Congressional Passage of the 1987 Nursing Home Reform Act.

The 2008 CMS Action Plan for (Further Improvement of) Nursing Home Quality

Lists the Agency's participation in the culture change movement as part of the Quality Improvement component of the five inter-related and coordinated approaches to ensuring quality. CMS also cites culture change as "echoing OBRA principles of knowing and respecting each nursing home resident and providing individualized care that best enhances quality of life."

Use of Civil Monetary (CMP) Funds by States Memorandum
Discusses "Appropriate CMP Fund Use" including culture change efforts.

Nursing Home Culture Change Regulatory Compliance Questions and Answers
CMS responses to inquiries concerning compliance with the long-term care health and life safety code requirements in nursing homes that are changing their cultures and adopting new practices.

CMS Letter to Mississippi Congressional Delegation
Documents CMS participation in efforts to engage in communication with culture change innovators and to inform survey agencies of how these innovations can comply with Federal requirements.

Development of the Artifacts of Culture Change Tool
CMS Report on the "Development of the Artifacts of Culture Change Tool" with the tool included in an appendix of the document.

CMS SNF Payment Reg. Language
Final Centers for Medicare & Medicaid Services rule to encourage communication of information on culture change and to expand these innovative programs across the country.

The Environmental Side of the Culture Change Movement: Identifying Barriers and Potential Solutions to furthering Innovation in Nursing Homes
Pre-symposium Background Paper to the April 3rd, 2008 "Creating Home in the Home: A National Symposium on Culture Change and the Environment Requirements" by Carmen Bowman 

CMS Four Part Series: From Institutionalized to Individualized Care
This four part series was developed by CMS to demonstrate how nursing homes can achieve better clinical outcomes when they individualize their care delivery systems:

  • Part 1 - Integrating Individualized Care and Quality Improvement;
  • Part 2 - Transforming Systems to Achieve Better Clinical Outcomes;
  • Part 3 - Case Studies in Culture Change;
  • Part 4 - The How of Change: Workplace Practices and Workforce Stability.

Each part of the series is available under "Archived Webcasts" on the Survey & Certification Online Course Delivery System at:

CMS Guide to Choosing a Nursing Home
For the first time, this 2008-2009 publication references resident-directed care and culture change as important elements of consumer choice (pages 24-25). Pioneer Network is listed as a culture change resource.

The Centers for Medicare & Medicaid Services (CMS) developed this comprehensive online resource of quality improvement information for Medicare's National Quality Improvement Priority Topics.

Nursing Home Transparency Act of 2009
Bill Introduced to Support National Demonstration Projects on Culture Change