The 2021 Annual Section for Long-Term Care Regulation Provider Meeting was held virtually on November 10, 2021.

The recorded videos are available at https://missouri.qualtrics.com/jfe/form/SV_ehWffJkM2r7WSHk.

 

Many questions asked during presentation were asked and have been compiled into a document with answers in the attached Provider Meeting Q&A.

In response to some specific questions, please see this medical marijuana presentation that was given by SLCR.

 

Please see the agenda here.

PowerPoint Handouts
1. Welcome & Section Updates
2. Division Introductions
3. Nursing Home Discharges
4. The New CNA Testing Process
5. Immediate Jeopardy and Past Noncompliance
6. Psychosocial Impact
7. Oral Health
8. ICAR Project
9. Life Safety Code Presentation

 

CMS has issued updated visitation guidance for visitation in nursing homes. The new guidance includes that visitation is now allowed for all residents at all times. DHSS will be updating its guidance as well and it will be consistent with the CMS guidance. Long-term care facilities certified for Medicare and Medicaid are required to follow the CMS memo. All long-term care communities (SNF, ICF, ALF and RCF) may utilize the CMS guidance until the DHSS guidance is updated.

Please see the full memo at https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf.

19 CSR 30-82.010 General Licensure Requirements

The Department of Health and Senior Services, Section for Long-Term Care Regulation has drafted emergency and proposed amendments for regulation set 19 CSR 30-82.010 in order to create a temporary closure procedure for those Medicare and Medicaid federally certified facilities (intermediate care facilities and skilled nursing facilities) licensed in Missouri which experience staffing shortages from the COVID-19 vaccine mandate issued by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services emergency regulation 42 CFR part 483.

The emergency amendment for 19 CSR 30-82.010 was filed on November 10, 2021, with an effective date of November 29, 2021, and expiration of May 27, 2022. The emergency amendment can currently be viewed at: https://www.sos.mo.gov/CMSImages/AdRules/main/EmergenciesforInternet/19c30-82.010IE.pdf. The proposed amendment covering this same material will also be published in the same issue of the Missouri Register. The Register publication date is December 15, 2021 for the emergency and proposed amendments and can be found at: http://www.sos.mo.gov/adrules/moreg/moreg.asp.

NOTE: The public comment period for the proposed amendment will be from December 15, 2021 – January 14, 2022. The Department will be accepting comments during the comment period by mailing the comments to: Carmen Grover-Slattery, Regulation Unit Manager, Section for Long-Term Care Regulation, Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102-0570 or by emailing to: RegulationUnit@health.mo.gov.

The proposed amendment can be reviewed on our website at: https://health.mo.gov/about/proposedrules/.

A message from CMS

Thank you for your interest in in the COVID-19 Omnibus Vaccine Rule (IFC-6). Last week’s stakeholder call had a limit of 10,000 participants and we exceeded that number. Please accept our apologies.

CMS has posted the presentation slides and a recording of the stakeholder call for your convenience.

To view the slides, visit https://www.cms.gov/files/document/covid-19-health-care-staff-vaccination-ifc-6-national-stakeholder-call-slides.pdf.

To view the video, visit https://www.youtube.com/watch?v=xHA0zY1aC-Y.

In addition to the resources above, CMS has prepared a frequently asked questions document, available here: https://www.cms.gov/files/document/cms-omnibus-staff-vax-requirements-2021.pdf.

Our next stakeholder call will be held on:
Wednesday, November 10, 2021
3:30 – 4:30 PM EST
To register in advance, visit https://cms.zoomgov.com/webinar/register/WN_bCsmBuXfTnOCK0owoQVHvg.

After registering, you will receive a confirmation email containing information about joining the webinar.

*Please note we can only accommodate 10,000 participants so register early to guarantee your participation.*

Again, thank you for your interest in this important topic. We look forward to working with you and, appreciate your commitment to the safety of your staff and patients.

Exciting transformation is coming for the Level of Care (LOC) process effective 10/31/2021! Our current LOC Process (many of us have referred to as the DA124 A/B forms) is undergoing major changes!

Here are some of the highlights:

The application process will all be ELECTRONIC. You will fill out and submit forms online on the COMRU website at https://health.mo.gov/seniors/nursinghomes/pasrr.php. For example, the forms will be able to be sent from the hospital to the nursing home to COMRU, all in one system. This electronic link will be available starting October 29, 2021. COMRU will not process these application until November 1, 2021.

The process of evaluating Level of Care will also change. New areas will be evaluated and previous areas will be changed in order to provide the best assessment for determining Level of Care. You can read about the new process in the proposed Regulation at 19 CSR 30-81.030, https://health.mo.gov/about/proposedrules/, which will go into effect on 10/31/2021.

To help facilities prepare for these changes, COMRU hosted a webinar on 10/28/2021. The recorded version of the New LOC Webex Training may be found on the COMRU webpage. A Q & A document from this webinar is also available.

Additionally, COMRU will be hosting a follow-up Webex training for the LOC Transformation. Details below:

November 19, 2021 at 10:00 a.m.

When it’s time, join your Webex meeting here – Join meeting

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SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for 4/1/21 through 6/30/21 must be submitted no later than 11:59 p.m. on November 15, 2021.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 7/1/21 through 9/30/21 is due November 14, 2021. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline, as the Service Center will be unavailable to assist on the weekend. Therefore, phone and email support will be concluded as of Friday, November 12, 2021 at 8:00 p.m. (ET).More information about PBJ can be found on the following webpages:

December 8, 2021: Envisioning the Future: More to do in 2022

Pioneer Network is pleased to offer the fourth in its series of four Symposia for 2021, based on the theme, Envisioning the Future, and recognizing that there is More to Do in 2022. As the previous symposia have shared, we have learned a lot, but now the key is to take the lessons we have learned and use them to help us shape the future, one that is grounded on the principles of person-centeredness. The work ahead of us will not be easy, but Pioneer Network is pleased to be able to bring together a group of leaders who not only have the vision to lead the way, but who have begun the work needed to take us into the future.

You can access the most information related to Abbott of BinaxNOW tests that have been authorized to have their expiration dates extended by accessing information directly from Abbott’s website.  Use the instructions to see the letter and listing of BinaxNOW™ COVID-19 Ag Card lots which qualify for this expiry extension. Please pay close attention to the lot number, currently labeled kit expiry, and new kit expiry date. The image below helps you to locate the lot number of the Abbott BinaxNOW test kits.

November 2, 2021: FAQs for NHSN users that report weekly COVID-19 Vaccination Data for Long-term Care Facilities

CDC will host a webinar to review recent updates to the National Healthcare Safety Network (NHSN) weekly COVID-19 vaccination data reporting modules. This webinar will focus on addressing some of the frequently asked questions (FAQs) from facilities, reviewing data entry issues, and highlighting helpful training materials and resources.

Join the listen-only webinar to hear comprehensive responses to your FAQs based on the updates made to these modules. Thank you for submitting data to the NHSN weekly COVID-19 Vaccination Module for long-term care facilities.

Please use the link below to register:

Topic: FAQs for NHSN users that report weekly COVID-19 Vaccination Data for Long-term Care Facilities
Date: Tuesday, November 02, 2021
Time: 2:30 PM EST
Register in advance for this webinar:
https://cdc.zoomgov.com/webinar/register/WN_RI1J5TBRTmu0HiRKMALAtw

After registering, you will receive a confirmation email containing information about joining the webinar.

The Department of Health and Senior Services, Section for Long-Term Care Regulation has drafted emergency and proposed amendments regarding adding the level-of-care evaluation and assessment requirements back that were effective prior to October 31, 2021, in order for those individuals who would have qualified for Title XIX funded services prior to October 31, 2021, to be eligible to receive services funded through the American Rescue Plan Act (temporary enhanced federal medical assistance percentage). Therefore, a second level-of-care determination will be utilized from October 29, 2021, until the funding from the American Rescue Plan Act has been expended.

The emergency amendment for 19 CSR 30-81.030 was filed on October 15, 2021, with an effective date of October 29, 2021, and expiration of April 26, 2022. The emergency amendment can currently be viewed at: https://www.sos.mo.gov/adrules/EmergenciesforInternet/emergency. The proposed amendment covering this same material will also be published in the same issue of the Missouri Register. The Register publication date is November 15, 2021 for the emergency and proposed amendments and can be found at: http://www.sos.mo.gov/adrules/moreg/moreg.asp.

NOTE: The public comment period for the proposed amendment will be from November 15, 2021 – December 15, 2021. The Department will be accepting comments during the comment period by mailing the comments to: Carmen Grover-Slattery, Regulation Unit Manager, Section for Long-Term Care Regulation, Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102-0570 or by emailing to: RegulationUnit@health.mo.gov.

The proposed amendment can be reviewed on our website at: https://health.mo.gov/about/proposedrules/.

Exciting transformation is coming for the Level of Care (LOC) process effective 10/31/2021! Our current LOC Process (many of us have referred to as the DA124 A/B forms) is undergoing major changes!

Here are some of the highlights:

The application process will all be ELECTRONIC. You will fill out and submit forms online on the COMRU website at https://health.mo.gov/seniors/nursinghomes/pasrr.php. For example, the forms will be able to be sent from the hospital to the nursing home to COMRU, all in one system. This electronic link will be available starting October 29, 2021. COMRU will not process these application until November 1, 2021.

The process of evaluating Level of Care will also change. New areas will be evaluated and previous areas will be changed in order to provide the best assessment for determining Level of Care. You can read about the new process in the proposed Regulation at 19 CSR 30-81.030, https://health.mo.gov/about/proposedrules/, which will go into effect on 10/31/2021.

To help facilities prepare for these changes, COMRU will be hosting a webinar. Additional trainings to follow.

Thursday, October 28, 2021 at 10:00 a.m.

Join from the meeting link
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Meeting password: 3YXgTsdkc37

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The Long-Term Care Ombudsman Program would like to know if you are interested in recognizing your facilities Resident Council President by posting a sign outside of their room identifying them and their role.

Some of the benefits are:

  • Increasing the Presidents confidence in their role, boosting overall morale
  • Other residents can easily identify who their President is and know where to go if they need to talk
  • Promotes awareness to new residents and families that a Resident Council exists and provides a point of contact

State Office would be in charge of designing and purchasing the signs. But before we do, we want to know if this is something to pursue based off your feedback.

Please provide your feedback by completing this brief, two question Survey Monkey. All submissions are anonymous.

You can find the survey here https://www.surveymonkey.com/r/DMSNHTH. The survey will close Tuesday, November 9, 2021.

The NEW! who/where/what of wearing PPE in your facility.

Click HERE for the most updated document from QIPMO.

The October 2021 Resident Advocate is now available.

This issue includes:

  • Residents Across the Country Share Their Experiences Living in a Nursing Home
  • Compassionate Care Visits – Must Be Individualized and Person-Centered
  • The Fight Against Chemical Restraints

This newsletter is a great resource to share with long-term care residents. Nursing home staff, long-term care Ombudsman programs, family members, and other advocates are encouraged to forward this newsletter to residents or print and share copies with residents. Download this issue or past issues from this webpage.

November 16, 2021: Recharge with a Nature Fix
Speaker: Tammy Marshall, Biophiliac & Longevity Expert and Founder & CEO of Biophilia Pharma

Join Pioneer Network for the last of the 2021 Share the Vision webinars, where speaker, Tammy Marshall, Biophiliac & Longevity Expert and Founder & CEO of Biophilia Pharma, will share with attendees the power of nature in supporting health and well-being – not only the residents you support, but for you!

Tammy will explain the value of nature as a health equity and the science behind nature immersion (Yes, spending all those hours outdoors engaging with nature has value beyond just the fact that you like it and it is fun!) She will share tips on how you can find yourself a nature fix, how it is all about knowing thyself.

In Tammy’s work, she has seen how supporting residents so that they can enjoy the outdoors is often very challenging for care communities, and as we approach the winter months, that challenge can become greater, and so Tammy will also be sharing ways to bring the outdoors in.

November 19, 2021: Creating Connectedness
Presenter and Host: Carmen Bowman

LTC communities face daunting challenges when it comes to the difficulties of staffing right now. Employees have increased expectations of their leaders and managers than in the past. For organizations to thrive during rapid change, they need a mindset shift from traditional problem solving to an increased emphasis on the needs of the employee and the vital roles they hold. Learn to identify the top reasons why employees leave, and ideas for a culture that honors and includes employees like never before.

Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation in partnership with MU Sinclair School of Nursing, this year’s SLCR Provider Meeting will be held virtually.

Wednesday, November 10, 2021

With the meeting being conducted virtually this year, registration will be required. The link to register along with session information will be coming soon. Please stay tuned to the LTC Information Update for more details.

CMS released a PDF file labeled “MDS 3.0RAIManualv1.17.1R.Errata.October.1.2021,” available in the Downloads section of the MDS 3.0 RAI Manual webpage. This file contains revisions to pages in Chapter 6 of the MDS 3.0 RAI Manual v1.17.1R that update the NTA Comorbidity Score Calculation table. Changed manual pages are marked with the footer “October 2019 (R).” The errata document begins with a table that lists all identified revisions and the pages to which they have been applied. Following the table are the actual corrected replacement pages for insertion into the printed manual.

Long-Term Care (LTC) Facility COVID-19 Testing Requirements (QSO 20-38-NH, revised 9/10/2021)

Please read the memo carefully. CMS has revised testing requirements for nursing homes including testing of symptomatic residents and staff, and routine testing of staff. Two major changes are:

  • Facilities now have two options to conduct outbreak testing, through either a contact tracing or broad-based testing approach. See Table 1.
  • Routine staff testing is now based on the facility’s county level of community transmission instead of county test positivity rate. The link to determine county level of community transmission is in the memo. The frequency of testing has also been updated. See Table 2.

 

Table 1: Testing Summary

Testing Trigger

Staff

Residents

Symptomatic individual identified

Staff, vaccinated and unvaccinated, with signs or symptoms must be tested.

Residents, vaccinated and unvaccinated, with signs or symptoms must be tested.

Newly identified COVID- 19 positive staff or resident in a facility that can identify close contacts

Test all staff, vaccinated and   unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual.

Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual.

Newly identified COVID- 19 positive staff or resident in a facility that is unable to identify close contacts

Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility).

Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility).

Routine testing

According to Table 2 below

Not generally recommended

 

Table 2: Routine Testing Intervals by County COVID-19 Level of Community Transmission

Level of COVID-19 Community

Transmission

Minimum Testing Frequency of

Unvaccinated Staff+

Low (blue)

Not recommended

Moderate (yellow)

Once a week*

Substantial (orange)

Twice a week*

High (red)

Twice a week*

+Vaccinated staff do not need to be routinely tested.

 

Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19-0.