As the primary funder of long-term care services and supports under the Medicaid Program, CMS maintains a vital interest in the paid and informal direct service community workforce. In the past 10 years, CMS has committed substantial resources to improving the recruitment and retention of direct service workers (DSW) through its Real Choice Systems Change grants, 10 direct care community workforce demonstration grants and national evaluations of them, and the creation of the National Direct Service Workforce Resource Center (RC). The RC provides:

• General Technical Assistance on DSW issues to a wide range of stakeholders through an established infrastructure which includes: a newsletter, website, toll free number, a network of key informants from numerous federal agencies on DSW issues, and technical assistance documents developed by the DSW RC on best practices and cutting edge issues;
• Intensive TA directly to states utilizing an established network of national experts;
• Peer to Peer Learning Experiences through conference calls and face-to-face meetings for states and other stakeholders to share their challenges and successes;
• A Forum to identify and address issues affecting both family and paid caregivers.

CMS also works with other federal agencies and stakeholders to build consensus around DSW issues. For instance, CMS participates on the HHS Workforce Work Group and several of its sub-committees on implementing the various workforce provisions in the Accountable Care Act. CMS is also involved with the Secretary's Community Living Initiative, and CMS staff co-chairs the Workforce Workgroup with staff from the Administration on Aging.

CMS, with assistance from the DSW RC, collaborated with:

• The Department of Labor to host a National Symposium on Strengthening the HCBS Direct Service Workforce in 2008; and
• The Office on Disability and the Administration on Aging to sponsor a Summit on Building Capacity and Coordinating Support for Family Caregivers and the Direct Service Workforce in 2010.

The DSW RC's website has information on CMS's TA activities. In addition, documents developed by the RC include a synthesis of cross-disability DSW issues and a case for monitoring the direct service workforce and makes recommendations for data collection. The document has been instrumental in guiding CMS thinking about the need for and development of DSW cross-population core competencies and recommends six core data elements states should collect on their DSW workforce to determine workforce stability and volume and worker compensation. Selected states are currently participating in a data collection effort to assess how viable these key indicators are as a minimum data set on the DSW workforce