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PASRR rules must recognize that people with serious mental illness may not show significant change but still may have unmet mental health needs. 

LTSS consumers should have access to a full range of mental health services.

Funds should be provided for education and training for long-term services and supports (LTSS) workers, especially those in short supply, such as certified nursing assistants. 

Policymakers should remove barriers to the effective use and hiring of APRNs, such as nurse practitioners, in all LTSS settings.

Federal and state governments must ensure that Medicaid and other public program reimbursements are sufficient to pay wages and benefits that will attract and retain LTSS workers.

Policymakers should require a comprehensive national background check prior to employment for all LTSS workers.

Program participant cost-sharing for either community or institutional services should be modest. It should not favor one type of service over another.