Policy & Regulations
Building Partnerships to Expand the Movement
As a national initiative, THE GREEN HOUSE® Project partners with policymakers to remove barriers and create incentives for organizations to implement The Green House model. In a February 2007 letter, Leslie Norwalk, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), found “no barriers” that would prevent Green House homes adhering to the model’s principles from being “qualified as nursing homes under federal regulations.”
THE GREEN HOUSE REVOLUTION IN NURSING HOMES: PUTTING HOME AND HEART INTO LONG-TERM CARE
…And here we are today – with Green House Number 100. Today we cross the line separating where we started from where we’re going. Let me explain. It’s said that a healthy community is like a tree. When you plant a tree, you plant hope. You water it. You care for it. And if you’ve done it right, both tree and hope will grow.
The health of our communities is the same way. From cradle to grave, our health is shaped by where we live, learn, work and play. That’s the nurture and nature – that’s what makes us the way we are.
CMS Clarifies Guidelines Regarding Unsafe Food Sources in Long-term Care Facilities
In January 2009, The Green House Project wrote to the Centers for Medicare and Medicaid Services (CMS) on behalf of Green House providers to seek clarification on the intended impact and interpretation of new guidelines regarding unsafe food sources in long-term care facilities. CMS clarified that the guidelines are not intended to prohibit residents from consuming outside food, making the distinction between food procured by the facility and food procured by others and brought in to share with residents.
The Green House Model Meets California Regulatory Requirements for Role of Certified Nursing Assistants
In October 2008, The Green House Project met with the California Department of Public Health (CDPH) to review the state’s requirements as they apply to the roles, responsibilities, and supervision of Certified Nursing Assistants (CNA’s). The state’s Licensing and Certification Program agreed that the model’s core principles and practices met the intent and requirements of California nursing home regulations around health and safety, staff dietetic services, and nursing services.
CMS Finds ‘No Barriers’ to The Green House Model in Federal Nursing Home Regulations
In a February 2007 letter, Leslie Norwalk, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), found “no barriers” that would prevent Green House homes adhering to the model’s principles from being “qualified as nursing homes under federal regulations.”
Federal/State Panel on The Green House Model and Regulations
An April 2007 panel of state long-term care regulators and staff from the Centers for Medicare and Medicaid Services (CMS) discussed The Green House model and regulatory compliance at the American Association of Homes and Services for the Aging’s spring conference in Washington, DC. Each panelist offered advice on approaching CMS regional and state staff when planning a new Green House project.
CMS Regulatory Policy Guidance on Culture Change Practices
In a 2006 letter to State Survey Agency Directors, the Centers for Medicare and Medicaid Services (CMS) clarified their position on several questions, perceptions and misperceptions about common practices in nursing homes embracing culture change and person-centered approaches to care. The letter provides guidance and interpretation in many areas of nursing home practice that are changed in The Green House model and may serve as a valuable reference for projects in dialogue with state agencies.
Arkansas Bills Provide Planning Support, Staffing Flexibility, and Specialized Reimbursement for Green House Projects
Arkansas House Bills 1363 & 1364, signed into law in March 2007, provide Arkansas’ Office of Long-Term Care the ability to provide support, staffing flexibility, and specialized reimbursements to organizations interested in creating a Green House project or implementing an Eden Alternative program. House Bill 1363 amends Arkansas’ Long-Term Care Trust Fund, an account funded by nursing home’s civil monetary penalties, to allow the Director of the Office of Long-Term Care to use funds from the trust to create programs supporting Green House projects or Eden Alternative Programs. Discussions with the Office of Long-term Care indicate that planning grants for Green House adopters may be one such program. House Bill 1364 amends Arkansas’ Code relating to nursing home staffing standards to allow The Office of Long-Term Care to create separate staffing standards and reimbursement categories for Green House projects or Eden Alternative homes as determined necessary.
Oklahoma “Green House” Bill Signed – Provides Regulatory Flexibility
In 2007, Governor Brad Henry signed House Bill 1510, which helped to bring The Green House Project to Oklahoma. The legislation gave the Commissioner of Health the ability to waive certain provisions of the Oklahoma Nursing Home Care Act if necessary to restore “Individuals to a self-contained residence in the community that is designed like a private home and houses no more than 10 individuals.” While The Green House Project does not typically need waivers to operate under state guidelines, the added flexibility is an excellent tool to have available.
Wyoming Long-Term Care Choices Act – Creates Pilot Program for The “Green House” Project
In 2007, Wyoming adopted the Long-Term Care Choices Act (SF89). The Act covers several items relating to long-term care, including creating an “alternative elder care home” category (modeled on The Green House Project principles) and a feasibility grant to fund the exploration of one Alternative Elder Care Home. The Elder Care Home must provide a “residential home environment” to Medicaid supported residents, including private bedrooms and baths, a den, an open kitchen (implied), an office for a nurse, open access to all areas of the house and a secured patio during waking hours, overhead lifts, a restraint-free environment, and self-managed work teams of direct care and nursing staff.
Massachusetts Issues Certificate of Need for The Green House Project in Chelsea – First in 10 Years
On July 8, 2006, Section 116 of Chapter 139 of the Acts of 2006 became law in Massachusetts, providing a Certificate of Need for 100 new skilled nursing beds to be developed using The Green House model of care by Chelsea Jewish Nursing Home. This is the first approval for new nursing beds to be granted in the state in the past 10 years.