The Centers for Medicare & Medicaid Services (CMS) on Thursday reviewed multiple updates with skilled nursing operators, with agency officials discussing Minimum Data Set changes and the Five-Star Rating System, along with a rundown of changes to its proposed rule.
CMS is planning to re-specify some of the measures listed in Five-Star, as they’re tied up in the soon to be replaced Section G of the MDS, according to Heidi Magladrey, coordinator for the Skilled Nursing Facility Quality Reporting Program at CMS.
“We’ll be releasing guidance about quality measures in any potential new [MDS] training. But I think that work is still in the works right now,” said Magladrey.
Jacob Berelowitz, program manager for the Center of Excellence for Behavioral Health in Nursing Facilities, also presented available resources for SNFs to better address mental wellbeing for their residents.
The added assistance is notable given the Biden administration’s focus on behavioral health wellbeing in nursing homes being part of reform initiatives. Updates to rules of participation, and most recently the planned targeted as well as off-site audits all focused on the accurate assessment and coding of individuals diagnosed with schizophrenia.
“I think this is a valuable piece. Facilities are going to need some real resources to be able to affect the requirements for things like trauma-informed care,” Joel Van Eaton, EVP of post-acute care regulatory affairs and education at Broad River Rehab, told Skilled Nursing News.
Behavioral health support
CMS and Substance Abuse and Mental Health Services Administration (SAMHSA) created the Center of Excellence for Behavioral Health in Nursing Facilities as a three-year grant project in September 2022.
“There are at least two and a half years remaining for you to take advantage of this program,” Berelowitz told listeners. He is a licensed nursing home administrator and social worker, working for the last 15 years in long-term care. “This new one that we’re talking about today is specifically focused on nursing facilities.”
The grant project will serve as a centralized hub for expanding capacity in CMS-certified nursing facilities to care for residents with a variety of behavioral health conditions, train staff on such conditions, and offer technical assistance and workforce development.
Ten regional behavioral health specialists will be available to SNF operators for support, Berelowitz said.
The center is focused on four behavioral health areas. These include serious mental illnesses, such as schizophrenia, bipolar disorder, or major depression, as well as serious emotional disturbances, which are conditions that affect the pediatric nursing facility population. The center also focuses on substance abuse disorders, including alcohol, opioids or other addiction disorders. And finally, it oversees co-occurring disorders when a patient has both a mental illness and substance abuse disorder.
Notably absent is dementia, Berelowitz said, especially dementia present in nursing home residents younger than 65.
The grant was awarded to Alliant Health Solutions, a nonprofit organization helping to improve quality in nursing homes and with behavioral health initiatives.
Commentary on MDS changes
Concerning MDS changes, industry participants expressed concern that there weren’t more ways to provide feedback on the changes.
“I was a little disappointed that there’s not a public website or email where comments can be made about the current manual,” said Van Eaton.
American Association of Post-Acute Care Nurses (AAPACN) is putting together comments, he said, but SNF staff members that perhaps don’t have access to AAPACN are left without a voice on the MDS changes.
“I think it would be helpful for them to have a broader reaching ability to hear from people,” said Van Eaton, who serves on AAPACN’s expert advisory panel and is also on the foundation board.
In the meantime, operators are waiting on scheduled trainings due to be announced in the coming months now that the MDS Resident Assessment Instrument (RAI) manual has been revised, with plenty of details and clarification on discharge planning, transportation, health literacy and social isolation assessments.
“Everybody’s looking forward to the separate package of information related to the optional state assessment (OSA) at the end of this month, or beginning of May,” added Van Eaton. “That will be helpful to understand what their expectations are, if it’s going to be used.”
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