By James Mauldin, MD, Chief Medical Officer
The Medical Minute – BHS Newsletter March 3, 2025
Hi! I’m James Mauldin, MD, Chief Medical Officer at Behavioral Health Solutions (BHS), and I’m excited to welcome you to the inaugural issue of our newsletter. A little about me: I’ve been with BHS since 2022, bringing over 25 years of experience in post-acute and long-term care, hospital psychiatry, county mental health, and addictions medicine. At Behavioral Health Solutions, we are a dedicated team of licensed mental health professionals focused on improving the quality of care in skilled nursing and long-term care facilities.
Our services span psychiatric medication management, therapy, neuropsychology, and education, all geared toward addressing the mental health needs of the elderly. From primary dementias and their complications to depression, severe mental illnesses, anxiety disorders, and substance abuse, we provide specialized care to enhance the well-being of our residents. Additionally, we support nursing homes that admit residents with primary psychiatric conditions and severe behavioral disturbances, and actively advocate for increased funding at the state level to enhance these vital services.
With operations in nine states and expanding, our team consists of over 165 mid-level providers and therapists, guided by 12 board-certified psychiatrists and 4 licensed psychologists. Our collective expertise ensures we deliver compassionate, evidence-based care, while also helping facilities navigate a complex regulatory environment.
Recent CMS Medication Management Guidelines
A significant update from the Centers for Medicare & Medicaid Services (CMS) is the revision of Medication Management and Freedom from Chemical Restraints regulations, as outlined in the latest long-term care surveyor guidance. These revised guidelines aim to improve resident safety, reduce unnecessary psychotropic drug use, and prioritize person-centered care. I’d like to take a moment to outline these changes and how Behavioral Health Solutions is prepared to help our clients comply while providing exceptional care.
The new guidelines provide a clear definition of chemical restraints as any medication used to control behavior or restrict movement without a valid medical indication. Medications should not be used for staff convenience or as a replacement for comprehensive care. Facilities are encouraged to use non-pharmacological interventions, including behavioral therapies, environmental modifications, and increased resident engagement. This includes staff training in de-escalation techniques and specialized dementia care.
Focus on Psychotropic Medication Oversight
The revised guidance places additional emphasis on the oversight of psychotropic medication use. Facilities are now required to document clinical rationales for prescribing these medications, including detailed records of symptoms, non-pharmacological interventions attempted, and any unsuccessful gradual dose reduction (GDR) efforts. This is crucial for residents with dementia, as inappropriate use of antipsychotics and psychotropics can lead to adverse effects such as sedation, falls, confusion, and increased risks of stroke or mortality.
The updated regulations also stress that GDRs for psychotropics must be attempted at least twice within the first year of prescribing unless there is clear documentation to support the continued use of these medications. At Behavioral Health Solutions, we are fully committed to supporting facilities in updating policies, providing staff education, and enhancing documentation and monitoring systems to ensure full compliance with these critical guidelines.
Our Commitment to Quality Care
Navigating these new regulations can be challenging, but our goal is to guide facilities through this process while continuing to deliver the high-quality, compassionate care our residents deserve. Behavioral Health Solutions remains steadfast in our commitment to helping long-term care facilities meet these new standards, ensuring that every resident receives the best possible care in a safe, supportive environment.