SA Determination of Necessary Staff

4514 - SA Determination of Necessary Staff (Rev. 1, 05-21-04) 4514A - Full-Time (Rev. 1, 05-21-04) “Full-time staff” as used here means persons who devote their entire time to the State survey program, and who are employed by the State on a full-time basis. The number and composition of the full-time staff identified with survey and certification activities should be sufficient to provide for timely and efficient program direction and coordination. The determination of necessary full-time staff is to be based on organizational arrangements and workload in each agency. At a minimum, each agency whose workload requires two or more staff-years of activity in a fiscal year should consider establishing a “full-time” professional position. The incumbent of this position would provide continuous program direction and, as appropriate in the context of agency workload, might also perform line functions. Neither this section nor Subsection B apply to full-time equivalent positions described in Subsection C. 4514B - Limitation of Full-Time Identifiable Positions (Rev. 1, 05-21-04) The number of persons on duty at the end of a monthly reporting period who occupy full- time identifiable positions in the State survey program is limited in any category (professional or clerical) to the number of such positions approved in the budget for that period, unless prior authorization to exceed that number is obtained from CMS. 4514C - Part-Time and Temporary (Rev. 1, 05-21-04) To augment the full-time State survey staff with the appropriate professional specialties required to perform State survey activities, the SA is authorized to: • Recruit part-time or temporary State employees; or • Arrange for part of the working time of full-time State employees (multi-program staff). Both types of employees are considered part-time employees to the survey program. As a general rule, consultants are not included in this category unless they are employees of the State. See §4611 for instructions relating to budget requests for consultants’ fees. Provision is made for “equivalent” positions to allow regular agency personnel to perform State survey functions where the agency’s regular personnel are already fully occupied and unable to devote time to this function unless the equivalent of the human resources used is added to their regular staff. Under this concept, an agency that estimated that the aggregate total time of multi- program personnel to be devoted to the State survey program would equal the time of one (or more) full-time person, could hire, with CMS approval, one (or more) full-time person as an “equivalent.” In such cases, the agency with approval could also purchase equipment needed by the persons hired. However, it is essential that the individual’s time be fully offset by time spent on the State survey program by other staff of the agency. The SA must maintain time records to validate charges to the State survey program. 4514D - Charging for Multi-Program Staff - Program Activities Readily Identifiable (Rev. 1, 05-21-04) In agencies where the function performed is separate and readily identifiable as serving the State survey program only, charges for multi-program staff performing State survey functions might be based on daily estimates of time spent on these functions, periodic sample time studies, or continuous time records. Periodic sample time studies must be approved by CMS in advance before the SA can use them as a basis for making charges under this section. 4514E - Charging for Multi-Program Staff - Program Activities Not Separate (Rev. 1, 05-21-04) Where some or all of the State survey activities are shared with other on-going agency programs so that a common function, e.g., survey of a hospital, will serve for State survey and certification as well as for licensure or other State programs and the work involved cannot be separated into program elements, time records may not be an appropriate basis for determining cost to the State survey program. The SA may use one of the following methods or submit another proposal for apportioning costs between the State survey program and the other agency program(s) involved. 1 - Cost Due to Acceleration of Usual Agency Functions Where the agency can identify an increase in its usual workload that is caused by such program requirements as recertification deadlines, the State survey program share would be equivalent to the cost of accomplishing this incremental workload. Charges would be substantiated by records indicating that the usual workload as well as the increase for the State survey program was, in fact, accomplished. If possible, substantiate charges by agency data on human resource requirements necessary for this workload, e.g., previous studies of time or human resources required for surveys of facilities in other agency programs. 2 - Ratio of Specific Workload Requirements of State Survey Program to Total Workload Requirements of All Agency Programs Involved This method may be used when the SA can identify countable activities (standards) for each type of survey which: • Need to be evaluated because of the requirements of the State survey program, and • Others that are related more to the requirements of another program. The ratio of countable activities required by the State survey program to the sum of the countable activities required by all programs could then be applied to the cost of the multi-program activity. Specific applications of this general principle would have to be developed jointly to allow for circumstances a particular agency may encounter and take into account the comparability of such activities between programs. All such proposals require approval by CMS before charges can be made under them. In some instances the comparability of activities or adjustments made in treating countable activities may have to be verified by later operational studies.