This federal CMS regulation (F949) requires Medicare/Medicaid-certified nursing facilities (long-term care facilities) to develop, implement, and maintain a behavioral health training program for all staff, contractors, and volunteers. Training must be tailored to the facility's resident population and assessment findings, and must cover competencies such as person-centered care, interpersonal communication, non-pharmacological approaches, and care for residents with mental, psychosocial, substance use, trauma-related, or dementia diagnoses. Facilities must track staff participation and monitor training effectiveness, revising the program as the resident population or facility assessment changes.
View official sourceF949 (Rev. 225; Issued: 08-08-24; Effective: 08-08-24; Implementation: 08-08-24) §483.95 Training Requirements. Training topics must include but are not limited to— §483.95(i) Behavioral health. A facility must provide behavioral health training consistent with the requirements at §483.40 and as determined by the facility assessment at §483.71. GUIDANCE §483.95(i) All facilities must develop, implement, and maintain an effective training program for all staff, which includes, at a minimum, training on behavioral health care and services (consistent with §483.40) that is appropriate and effective, as determined by staff need and the facility assessment (as specified at §483.71). For the purposes of this training requirement, staff includes all facility staff, (direct and indirect care functions), contracted staff, and volunteers (training topics as appropriate to role). Changes to the facility’s resident population, staff turnover, the facility’s physical environment, and modifications to the facility assessment may require ongoing revisions to the facility’s training program. There are a variety of available methods to provide training, including in-person instruction, webinars, and/or supervised practical training. Supervised practical training means training in a setting in which instruction and oversight are provided by a person who has relevant education and/or experience specific to the subject of the training being provided. All training should support current scope and standards of practice through curricula which detail learning objectives, performance standards, and evaluation criteria. There should be a process in place to track staff participation in the required trainings. A behavioral health training course as determined by the facility assessment should include, at a minimum, the competencies and skills necessary to provide the following: • Person-centered care and services that reflect the resident’s goals for care; • Interpersonal communication that promotes mental and psychosocial well-being; • Meaningful activities which promote engagement and positive meaningful relationships; • An environment and atmosphere that is conducive to mental and psychosocial well-being; • Individualized, non-pharmacological approaches to care; • Care specific to the individual needs of residents that are diagnosed with a mental, psychosocial, or substance use disorder, a history of trauma and/or post-traumatic stress disorder, or other behavioral health condition; and • Care specific to the individual needs of residents that are diagnosed with dementia (CMS Hand in Hand: A Training Series for Nursing Homes is an example of training that addresses this area). PROBES §483.95(i) If there is a concern that the behavioral health needs of residents are not being met, utilize observations, interviews and review of training records to determine the following: • Does staff demonstrate the skills needed to promote the highest practicable level of functioning for residents with identified behavioral health care needs? • Can staff explain concepts learned in training? • How does the facility assure that all staff interacting with residents are trained as required? This may include nursing, therapy, activity, housekeeping, dietary staff, and others, as needed. • How does the facility assure that all facility staff, contractors, and volunteers are trained to interact with those residents with specific behavioral health care needs? • Is the training program designed to address the residents’ specific behavioral health care needs? • How does the facility keep track of staff participation in required training? • How does the facility monitor the effectiveness of the training program? • How are changes implemented to the training program if desired outcomes are not achieved? • Is the training curriculum based on the results of the facility assessment required at 483.71 Transmittals Issued for this Appendix Rev # Issue Date Subject Impl Date CR# R232SOM 07/23/2025 Revisions to State Operations Manual (SOM), Appendix PP 04/28/2025 N/A R231SOM 07/09/2025 Revisions to State Operations Manual (SOM), Appendix PP- Rescinded and Replaced with Transmittal 232 04/28/2025 N/A R229SOM 04/25/2025 Revisions to State Operations Manual (SOM), Appendix PP- Rescinded and Replaced with Transmittal 231 04/28/2025 N/A R225SOM 08/08/2024 Revisions to State Operations Manual (SOM), Appendix PP 08/08/2024 N/A R211SOM 02/03/2023 Revisions to State Operations Manual (SOM), Appendix PP 10/24/2022 N/A R208SOM 10/21/2022 Revisions to State Operation Manual (SOM), Appendix PP Guidance to Surveyors for Long Term Care Facilities 10/24/2022 N/A R207SOM 09/30/2022 Revisions to State Operation Manual (SOM), Appendix PP Guidance to Surveyors for Long Term Care Facilities 10/01/2022 N/A R173SOM 11/22/2017 Revisions to State Operation Manual (SOM), Appendix PP Guidance to Surveyors for Long Term Care Facilities 11/28/2017 N/A R168SOM 03/08/2017 Revision to State Operations Manual (SOM) Appendix PP - Incorporate revised Requirements of Participation for Medicare and Medicaid certified nursing facilities 03/08/2017 N/A R167SOM 02/10/2017 Revision to State Operations Manual (SOM) Appendix PP - Incorporate revised Requirements of Participation for Medicare and Medicaid certified nursing facilities – Rescinded and replaced by Transmittal 168 02/10/2017 N/A R157SOM 06/10/2016 Revisions to the State Operations Manual (SOM) - Appendix PP – Guidance to Surveyors for Long Term Care Facilities 06/10/2016 N/A R149SOM 10/09/2015 State Operations Manual (SOM) for All Types of Providers and Suppliers Subject to Certification 10/09/2015 N/A R133SOM 02/06/2015 Revisions to State Operations Manual (SOM), Appendix PP – “Guidance to Surveyors for Long Term Care Facilities” 02/06/2015 N/A R130SOM 12/12/2014 Revisions to State Operations Manual (SOM), Appendix PP – “Guidance to Surveyors for Long Term Care Facilities” 12/12/2014 N/A R127SOM 11/26/2014 Revisions to State Operations Manual (SOM), Appendix PP – “Guidance to Surveyors for Long Term Care Facilities” 11/26/2014 N/A R107SOM 04/04/2014 State Operations Manual (SOM) Appendix PP LTCF revisions for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) 04/04/2014 N/A R70SOM 01/07/2011 Revisions to Appendix PP, State Operations Manual (SOM):Guidance to Surveyors for Long-Term Care Facilities (LTC) for Minimum Data Set (MDS) Implementation October 1, 2010 – Rescinded and replaced by Transmittal 70 10/01/2010 N/A R66SOM 10/01/2010 Revisions to Appendix PP, State Operations Manual (SOM):Guidance to Surveyors for Long-Term Care Facilities (LTC) for Minimum Data Set (MDS) Implementation October 1, 2010 – Rescinded and replaced by Transmittal 70 10/01/2010 N/A R55SOM 12/02/2009 Revisions to Appendix PP, - “Guidelines for Long-Term Care Facilities”, Tag F441 09/30/2009 N/A R54SOM 11/30/2009 Revisions to Appendix PP, - “Guidelines for Long-Term Care Facilities”, Tag F441 – Rescinded and replaced by Transmittal 55 09/30/2009 N/A R52SOM 09/25/2009 Revisions to Appendix PP, - “Guidelines for Long-Term Care Facilities”, Tag F441 – Rescinded and replaced by Transmittal 54 09/30/2009 N/A R51SOM 07/20/2009 Revisions to Appendix PP, - “Guidelines for Long-Term Care Facilities”, Tag F441 – Rescinded and replaced by Transmittal 52 09/30/2009 N/A R48SOM 06/12/2009 Revisions to Appendix PP, - “Guidelines for Long-Term Care Facilities” 06/12/2009 N/A R41SOM 04/10/2009 Revisions to Appendices P and PP 04/10/2009 N/A R36SOM 08/01/2008 Revisions to Appendix PP - Interpretive Guidelines for Long-Term Care Facilities, Tags F325 and F371 09/01/2008 N/A R26SOM 08/17/2007 Revised Appendix P and Appendix PP-New Tag F373 08/17/2007 N/A R22SOM 12/15/2006 Revisions to Appendix P and PP 12/18/2006 N/A R21SOM 10/20/2006 Revised Appendix P &Appendix PP-New Tag F334 10/15/2006 N/A R19SOM 06/01/2006 Revisions to Appendix PP 06/01/2006 N/A R15SOM 11/28/2005 Medical Director Guidance 11/25/2005 N/A R14SOM 11/25/2005 Medical Director Guidance – Replaced by Transmittal 15 11/25/2005 N/A R12SOM 10/14/2005 Appendix PP Technical Corrections 10/14/2005 N/A R08SOM 06/28/2008 Revision of Appendix PP-Section 483.25(d)- Urinary Incontinence, Tags F315 and F316 06/27/2005 N/A R07SOM 06/27/2005 Revision of Appendix PP-Section 483.25(d)- Urinary Incontinence, Tags F315 and F316 – Replaced by Transmittal 8 06/28/2005 N/A R05SOM 11/19/2004 Revisions to Appendix P and Appendix PP 11/19/2004 N/A R04SOM 11/12/2004 Guidance to Surveyors for Long Term Care Facilities 11/12/2004 N/A R01SOM 05/21/2004 Initial Release of Pub 100-07 N/A N/A