Diversifying Long-Term Care (LTC) Facility Services

Proposal Presented for the Master Plan for Aging (#7)

Disclaimer

Throughout the MPA process, more than 100 proposals were developed thanks in particular to thousands of hours of work by external stakeholders and members of the public. These proposals and the MPA Council commentary are being submitted to the Governor and shared with policymakers and the public to inform policymaking. These proposals represent a starting point for discussion. Further discussion is necessary between relevant state agencies and stakeholders to both refine these proposals and assess which may be appropriate to adopt and implement.

 

Summary

Diversify long-term care facility services to encourage high quality and person-centered specialized clinical services. This includes expansion of Adult Care Facilities (ACF)/Assisted Living (AL) and Adult Day Care access and expansion of access to and improved clinical expertise in psychiatric, mental health, and behavioral health services for long-term services and supports providers.

 

Justification

Regulatory and programmatic barriers impede access to appropriate providers and person-centeredness in facility-based long-term services and support settings. This limits options for individuals needing LTSS and hinders their ability to optimize their quality of life as their needs change with age. The development of specific mechanisms, such as reviewing operating and payment regulations, expansion of the Expansion for Community Healthcare Outcomes (ECHO) model, and expansion of availability of specialized workforce training could improve high quality and person-centered specialized clinical services. The goal of this proposal is the elimination of complicated regulatory compliance regarding staffing to assist the diversification of services to create an improved person-centered approach that will ensure high-quality and person-centered specialized clinical services are being made available to persons in long-term care facilities.

 

Full Proposal

Develop mechanisms to allow and encourage the provision of high quality and person-centered specialized clinical services to individuals receiving services in facility based LTSS settings:

  • Explore options to expand access to nursing services for ACF/AL residents.
  • Establish a DOH workgroup with stakeholders for issues of nursing within ACFs.
  • Review ACF/AL and Adult Day Health Care (ADHC) payment and operating regulations to ensure that they do not inhibit on-site visits by behavioral health providers (e.g., psychiatrists, psychiatric NPs, psychiatric social workers, substance used disorder treatment).
  • Allow co-location of services within all levels of facility-based LTSS care, including via a more flexible approach to the Home and Community Based Settings (HCBS) Rule [42 CFR Part 441].
  • Promote geriatric behavioral health services partnerships among behavioral health clinicians, hospitals, OMH- and OASAS-licensed providers, and long-term care providers.  Expand programs focused on psychiatric needs to a variety of LTC settings. Examine the adequacy of capacity in behavioral intervention units and the extent to which individuals are being admitted in out-of-state facilities or facilities distant from home.
  • Identify and eliminate regulatory and payment barriers that prevent OMH- and OASAS-licensed providers from bringing services on-site to LTSS facilities.
  • Explore payment incentives to encourage these partnerships.
  • Develop a virtual grand rounds platform to connect facility based LTSS providers with psychiatrists, social workers and family therapists experienced in the management of behavioral, mental, and cognitive health conditions (including PTSD, mental illness, substance use disorders, dementia with challenging behaviors, and developmental disabilities) to provide care consultation.
  • Expand the ECHO model – remote learning/collaboration model – to bring clinical expertise available in ECHO “hubs” to LTC providers. This is a potentially low-cost solution.
  • Expand the use of telehealth for behavioral health, in especially ACFs and Adult Day Health Care (ADHC), and update telehealth Dear Administrator Letter (DAL-DACF 23-27, DHCBS 23-04, and DNH 23-19).
  • Expand availability of specialized workforce training, technical assistance and supports in facility-based LTSS settings.
  • Leverage the Center for Excellence for Behavioral Health in Nursing Facilities – a SAMHSA-funded program.
  • Build an infrastructure for ongoing engagement among OMH, OPWDD, OASAS, and DOH and stakeholders that allows for a collaborative problem solving.
  • Conduct a 2-year post implementation evaluation to examine the impact of diversification on quality of care.
  • Develop a Department of Health workgroup to define quality as it relates to the proposed initiatives. 
 

 

MPA Council Commentary

This proposal may require an analysis of nursing home coverage across the state to review the availability of OMH providers with interest and experience working with older adults, existing resources, impact of offering these services, and existing service commitments. Components 4 and 9 of this proposal are categorized as long-term. Component 4 would require an assessment of existing federal rules and regulations. Component 9 may include the development of a new State Plan Amendment (SPA) to include Project ECHO GEMH as an education and consultation resource to nursing homes. Further specialization to add-on mental health services may also require an additional SPA and CMS approval. Components 5 and 10 of this proposal are currently being implemented by DOH and state agency partners. DOH could also provide forthcoming guidance to provide clarity regarding the expectations of Component 10. Funding components of the proposal would be subject to the annual budget process and the availability of resources.