Recommendation 7.1: The committee recommends that the Department of Health and Human Services fund research to examine the actual time and staff mix required in different long-term care settings to provide adequate processes and outcomes of care consistent with the needs and variability of consumers in these settings, and the fit between these needs and other existing staffing patterns. The Committee further recommends that the Department of Health and Human Services, by establishing Centers for the Advancement of Quality in Long-Term Care, initiate research, demonstration, and training programs for long-term care providers to redesign care processes consistent with best practices and improvements in quality of life.

Recommendation 8.1: The committee recommends that, before making decisions to reduce reimbursements, state officials carefully assess the impact on access to services and on quality of care of any proposed reductions in Medicaid reimbursements for nursing home, home health and other home and community-based services.

Recommendation 8.2: The committee recommends that the Department of Health and Human Services fund and support research to better understand the effects of payment policies on accessibility and quality of long-term care services, including the following:

• the effects of low reimbursement rates or changes in Medicare and Medicaid reimbursement policies on providers of nursing home, home health, or other long-term care services;

• the effects of current payment systems, such as prospective payment for nursing facilities and interim payment systems for home health agencies, on the accessibility and quality of services; and

• whether states with low Medicaid reimbursement rates (adjusted for geographic variation in prices and other state-specific requirements) have lower quality of nursing home care.