Pillars of Care

by | Nov 4, 2022 | CMS & OIG, Survey

Explore More Posts from MDS Consultants

Reviewing the Behavioral Health Pillars

The US Department of Health and Human Services (HHS) developed a roadmap for behavioral health integration to address a national mental health crisis.  The current Administration’s strategy is based on three core pillars:

1. Strengthen System Capacity 
2. Connect Americans to Care
3. Support Americans by Creating Healthy Environments

While the HHS Roadmap does not specifically address Skilled Nursing Facilities, it requires efforts throughout the healthcare system in all settings. Facilities should look to establish techniques early to avoid scrambling later on to keep up.

Long-term care facilities were mentioned specifically in the fact sheet from May 31, 2022. Specifically, the fact sheet states:

HHS is launching a new, $15 million funding opportunity to establish a Center of Excellence for Building Capacity in Nursing Facilities to Care for Residents with Behavioral Health Conditions, which will work to strengthen behavioral health care in long-term care facilities by improving mental health literacy and combating stigmatization among staff.

How should nursing homes respond to these initiatives?

When it comes to the Requirements of Participation, the recent QSO (Quality, Safety and Oversight) memorandum #22-19-NH indicates that:

CMS has identified a need to improve guidance related to meeting the unique health needs of residents with mental health needs and SUD (substance use disorder). We clarified that when facilities care for residents with these conditions, policies and practices must not conflict with resident rights or other requirements of participation. 
We further clarified that facility staff should have knowledge of signs and symptoms of possible substance use, and be prepared to address emergencies (e.g., an overdose) by increasing monitoring, administering naloxone, initiating cardiopulmonary resuscitation (CPR) as appropriate, and contacting emergency medical services. We also provided resources and non-pharmacological interventions, specific to residents living with mental disorders or substance use disorders, to assist providers in identifying alternative approaches to care to support this population.”

This indicates an expectation for each facility to develop treatment plans to properly care for residents with mental illness or substance use disorders. Staff should be well educated on treatment options and diagnoses to improve mental health literacy and reduce stigmatism.   Understanding nonpharmacological interventions may also decrease polypharmacy.  Future releases will surely provide more guidance as HHS seeks to achieve their goal.
The MDS assessment remains a central tool in identifying both medical and psychiatric symptoms in nursing home residents.

For those nursing facilities pursuing this new direction, we recommend three pillars specific to mental health and substance use disorder care within SNF’s to get us started:
1. Strengthen ability to care for psychiatric and substance use disorder residents
2. Connect residents to appropriate psychiatric providers and therapy
3. Maintain a supportive and non-stigmatizing environment of care

Our customers continue to age with conditions such as trauma, anxiety, and other psychiatric issues. We expect providing mental health care in SNF’s will continue to be required by both HHS and CMS. Ensuring that you and your staff are ready can help keep you balanced on these three pillars.

References

QSO-22-19-NH (cms.gov)

HHS Roadmap for Behavioral Health Integration Issue Brief

FACT SHEET: Biden-Harris Administration Highlights Strategy to Address the National Mental Health Crisis – The White House

Explore More Posts from MDS Consultants

Get ready for October 1

New 3-day Lookbacks | Assessment Periods

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of March 24, 2023 What You Can Expect to See New 3-day lookback/assessment periods are coming to the MDS world. There are different sections of the MDS that the Nurse Assessment Coordinators...

New Pain Interview in Section J

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 22, 2023 What You Can Expect to See The most noticeable changes to Section J are evident in the pain interview, specifically questions J0510, J0520 and J0530. The RAI Manual has...

Section B – Hearing, Speech and Vision Changes

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 15, 2023 What You Can Expect to See Section B on the MDS is a component of the Standardized Patient Assessment Data Elements (SPADEs), which is utilized across post-acute care...

Race and Ethnicity – Changes in Section A

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 7, 2023 What You Can Expect to See Section A, Identification Information for Race/Ethnicity has expanded. One of the major changes is the deletion of section A1000 Race/Ethnicity....

The New Section N: Use and Indication of High-risk Drug Classes

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of December 23, 2022 WHAT YOU CAN EXPECT TO SEE We will see changes in Section N of the MDS 3.0 effective on October 1, 2023.  Section N0410 (Medications Received) has been eliminated and is...

Read more on Toolbox Essentials

Focused Infection Control Surveys and Directed Plan of Correction

It's a dreary Monday morning, and the state surveyors walk into your facility to conduct a Focused Infection Control survey. You and your team have been trying your hardest to comply with infection control procedures throughout the pandemic. At the end of the survey,...

New Advanced Beneficiary Notice

Is your facility using the proper ABN form? The Centers for Medicare & Medicaid Services (CMS) recently updated the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The new ABN will be mandatory for use on 1/1/2021, but the new form can be...

Covid-19 and Skilled Status

In late June, CMS addressed two issues and posted MDS 3.0 Final Item Sets (V1.17.2).  The two edits were changes to facilitate the calculation of Patient-Driven Payment Model payment codes on OBRA assessments for states that wish to have this calculation performed. ...

Mind Your PHQs

Some skilled nursing facilities (SNFs) are concerned about accurate payment when a resident unexpectedly discharges and the Brief Interview for Mental Status (BIMS) has not yet been completed.However, they should be just as concerned about the PHQ-9. The PHQ-9...

MDS in the Emergency Preparedness Plan

The COVID-19 pandemic has highlighted the need for skilled nursing facilities to have an effective Emergency Preparedness Plan - one that includes sheltering-in-place. The Centers for Medicare and Medicaid Final Rule requires that participating providers have an...

MORE from MDS Experts

Transportation – New Item A1250

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of April 1, 2023 What You Can Expect to See An additional item we will see in the upcoming MDS 3.0 v.1.18.11 in October 2023 is A1250 - Transportation. This is included in a new subset of...

New 3-day Lookbacks | Assessment Periods

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of March 24, 2023 What You Can Expect to See New 3-day lookback/assessment periods are coming to the MDS world. There are different sections of the MDS that the Nurse Assessment Coordinators...

New Pain Interview in Section J

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 22, 2023 What You Can Expect to See The most noticeable changes to Section J are evident in the pain interview, specifically questions J0510, J0520 and J0530. The RAI Manual has...

Section B – Hearing, Speech and Vision Changes

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 15, 2023 What You Can Expect to See Section B on the MDS is a component of the Standardized Patient Assessment Data Elements (SPADEs), which is utilized across post-acute care...

Race and Ethnicity – Changes in Section A

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 7, 2023 What You Can Expect to See Section A, Identification Information for Race/Ethnicity has expanded. One of the major changes is the deletion of section A1000 Race/Ethnicity....

Webinars & Training

Grow your knowledge with our MDS education

MDS Guides & Forms

Exclusive resources & tools we use every day

Ask an Expert Forum

Members can get 1:1 advice from our MDS experts

RAC-CT & CTA Training

Learn from the best & build your expertise

News for MDS Experts

Browse our blog & get news alerts on MDS changes

MDS Completion

Get your MDS' done ASAP with short-term, expert help

Remote Floater

Fill gaps on your team when & where you need

Case Mix Index

Improve your complex case mix calculations

MDS System Mgt

Best practices for MDS schedules & workflow

More Services

Get help on PDPM, ICD-10, quality, schizoph. audits ++