Author: Leslie

2026 SLCR Annual Provider Meeting Topics

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The Section for Long-Term Care Regulation is currently in the planning phase for hosting in-person provider meetings across all regions this year. As we strive to provide the most beneficial information, we would love to hear your thoughts on what topics and information related to Long-Term Care you believe would be most helpful and educational to present this fall at the Annual Provider Meeting.

To gather your valuable feedback, we’ve created a quick one-question survey. Please take a moment to complete it by March 10, 2026. Your input is crucial in ensuring that our meeting addresses the most relevant and important topics for all attendees.

Thank you in advance for your time and participation. We look forward to hearing your suggestions and making this year’s meeting a success with your help.

Important Information on NOMNC and Discharge Notice Requirements

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A couple important reminders regarding the requirements for issuing Notices of Medicare Non-Coverage (NOMNC) and Discharge Notices. These two requirements are separate and cannot be used interchangeably.

Notice of Medicare Non-Coverage (NOMNC), Form CMS-10123

  • The NOMNC form is provided to Medicare beneficiaries in skilled nursing facilities and informs them that their Medicare covered services are ending.
  • Guidance from F581 includes:
    • The NOMNC must be given to all Medicare beneficiaries at least two days before the end of a Medicare covered Part A stay or when all Part B therapies are ending. The NOMNC informs beneficiaries of their right to an expedited review by a Quality Improvement Organization. Note the following exceptions: the beneficiary exhausts the SNF benefits coverage (100 days), the beneficiary initiates the discharge from the SNF, or the beneficiary elects the hospice benefit or revokes the hospice benefit to return to standard Medicare coverage.

Discharge Notice

  • The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless certain criteria are met, outlined in F627.
  • The facility must notify the resident and the resident’s representative of the reasons for discharge and a copy of the discharge notice must be provided to the Ombudsman. (F628)
  • Guidance from F628 includes:
    • For residents discharged home after a Medicare Part A stay, the discharge notice must be provided along with the NOMNC. The NOMNC does not replace the requirement for a discharge notice.
    • A discharge notice must be issued to residents regardless of the length of their stay. For example, if the resident is admitted for rehab and their Medicare Part A stay ends at 21 days, a discharge notice must still be issued. The notice must be issued “as soon as practicable” in this instance since the resident has not resided in the facility for more than 30 days.

The National Long-Term Care Ombudsman Resource Center has created a helpful resource for facilities highlighting the changes regarding Transfer and Discharge Notices, in Appendix PP that were effective April 25, 2025. We encourage facilities to review these requirements carefully and ensure that both the NOMNC and discharge notices are issued appropriately to comply with federal regulations and to protect the rights of residents.

Certified Nurse Aide Testing Reminders

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Federal regulations (F728) require skilled nursing facilities to ensure individuals working in the facility as a nurse aide are competent to provide nursing and nursing related services and to have successfully completed the training and passed the competency evaluation program (are certified as a nurse aide) within 4 months of hire. There are no extensions or waivers permitted beyond this time frame. Practices such as terminating a nurse aide and rehiring them to “restart the clock” are NOT permitted.

A facility must not use any individual working in the facility as a nurse aide who is unable to achieve the certification within the four-month time. Individuals can perform other functions in the facility for which they are trained and competent to perform, however they are not permitted to continue working in the role of a nurse aide until they have successfully completed their certification.

Skilled nursing facilities may not charge nurse aides for the costs associated with nurse aide training and testing, including up to three examination attempts. Skilled nursing facilities may be eligible for reimbursement of these expenses. Additionally, nurse aides who received training outside a nursing facility, but are employed by a SNF within one year, may be reimbursed for costs associated with their certification. A CNA Training Reimbursement webinar was presented by MO HealthNet that explains the process.

If you have questions or need assistance, please contact the Health Education Unit at CNARegistry@health.mo.gov or 573-526-5686.

Missouri launches Master Plan on Aging to build age-friendly communities

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The Missouri Department of Health and Senior Services (DHSS) announced the official launch of the Missouri Master Plan on Aging (MPA), a comprehensive 10-year roadmap designed to help Missourians age with dignity, safety and connection.

Aging with Dignity: Missouri’s Master Plan on Aging, was established by Governor Parson through executive order in January 2023. Developed with input from more than 10,000 residents statewide, including older adults, caregivers, individuals with disabilities and service providers, the MPA reflects what Missourians said matters most: affordable housing, reliable transportation, access to health care and strong support for family caregivers.

“The Master Plan on Aging is about creating communities where people of all ages can thrive,” said Sarah Willson, director of DHSS. “This plan turns ideas into action by providing practical tools for local leaders and organizations to make aging stronger, safer and more connected across Missouri.”

Key Features of the Missouri MPA

  • Seven Domains for Aging Well: Housing and aging in place; transportation and mobility; whole person health; safety and security; family caregivers; daily life and employment; and long-term services and supports.
  • Community-Driven, Collaborative Approach: The MPA was built from expertise and feedback gained from numerous statewide town halls, surveys and advisory committees.
  • Local Implementation Playbook: Practical guidance for counties, cities and coalitions to adapt statewide priorities to local needs.

Missouri’s population is aging rapidly. Estimates suggest that older adults will outnumber minors for the first time by 2030, and older adults will greatly outnumber minors by 2060. Additionally, approximately 15 percent of the state’s residents have a disability, the most common of which is mobility disabilities. As the population ages, the number of individuals with disabilities is expected to increase.

The MPA ensures communities are prepared to meet the needs of older adults and people with disabilities through coordinated, sustainable solutions.

Residents, organizations and local leaders are invited to participate in shaping age-friendly communities by using the local implementation toolkit.

View the complete Master Plan on Aging, or learn more about the process of creating the MPA on the DHSS website.

CNA Training Program Overview

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Skilled Long-Term Care Facilities who receive citations resulting in denial of payment effectuation, partial or extended survey, and/or civil monetary penalties over $13,343 (or as adjusted annually for inflation) will be prohibited from approval of the CNA Training Program for a 24-month time frame. This means the facility is not able to complete the 75 hours of instructional training as well as the 16 of the 100 hours of on-the-job training. The facility can only provide 84 of the 100 hours of clinical training with an approved clinical supervisor or instructor. To check for approved training facilities visit Certified Nurse Assistant (CNA) | CNA, CMT and Insulin Registry | Health & Senior Services and click on CNA Approved Facility Training Agencies.

Some facilities may be eligible for a federal waiver. If approved, this allows the facility to provide 175 hours of training with a sponsor. For more information, contact the Health Education Unit at 573-526-5686 or you may email us at CNARegistry@health.mo.gov.

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

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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. The following data must be submitted no later than 11:59 p.m. on February 17, 2026:

  • MDS data for 7/1/25 through 9/30/25;
  • NHSN data for COVID-19 Vaccination Coverage Among Healthcare Personnel for 7/1/25 through 9/30/25;

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.

Payroll-Based Journal (PBJ) Submission Deadline Reminder

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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 10/1/25 through 12/31/25 is due February 14, 2026. Please submit PBJ data as soon as possible to avoid delays.

QSO-26-03-NH: Revisions to the State Operations Manual (SOM) Chapters 5 and 7

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QSO-26-03-NH: Revisions to the State Operations Manual (SOM) Chapters 5 and 7 – CMS issued a memo and revisions to the State Operations Manual (SOM) Chapters 5 and 7, effective March 30, 2026.

Memorandum Summary

CMS is releasing the following guidance in Chapter 5 of the SOM:

  • Revisions to Immediate Jeopardy Priority Definition examples for Nursing Homes; and
  • Clarification of Off-site investigations.

CMS has updated and revised guidance in Chapter 7 of the SOM that includes:

  • Survey Team Composition, Survey Procedures, Plans of Correction, Verifying Corrections, Survey Revisit and Offsite Revisit Paper Review, Off-hours Survey, Enforcement, Nurse Staffing Waivers, Disposition of Civil Money Penalties (CMP), Federal Civil Penalties Inflation Reduction Act, Informal Dispute Resolution (IDR), and Independent Informal Dispute Resolution (IIDR);
  • Additionally, guidance previously found in Appendix P of the State Operations Manual has been added to Chapter 7; and
  • Technical changes that include updates for accurate references.

DHSS Health Update on Emerging Candida auris Infection Cases in Missouri Health Care Facilities

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The Missouri Department of Health & Senior Services (DHSS) continues detecting an increased number of cases of Candida auris (C. auris) within health care facilities across the state of Missouri. DHSS first identified locally acquired C. auris infection in October 2023. Please see the full Health Update for details.

Ombudsman Notification of Transfer/ Discharge for Certified Homes

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On November 18, 2024, the Centers for Medicare and Medicaid Services (CMS) released revised guidance for nursing home surveyors. Surveyors began using this revised guidance on April 28, 2025. As part of this revision, CMS has removed the terms “facility-initiated” and “resident-initiated” when referring to discharges. The updated guidance reiterates the language at 483.15(c)(3) that requires facilities to send a copy of all notices of transfer or discharge to the representative of the Office of the State Long-Term Care Ombudsman Program.

The Long-Term Care Ombudsman Program has developed an easy and efficient way for facilities to meet the ombudsman notification requirement for transfers and discharges. By completing the Transfer Discharge Ombudsman Notice and uploading the transfer/discharge notice, the requirement to notify the ombudsman program will be complete. Once the notice is submitted, the facility will receive an email notification as proof of submission. Completion of the survey with the notice attached will take the place of the monthly list and emailed notices to the regional programs. Requirements for content of transfer/discharge notices can be found at §483.15(c)(5).

Winter Weather

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Snow and ice are a mainstay of Missouri winter weather. Because of the variety of weather conditions as well as other events, facilities must have an emergency preparedness plan and be ready to act in an emergency to ensure they are to adequately prepared to meet the needs of patients, clients, residents, and participants during disasters and emergency situations.

If your facility experiences a loss of a necessary service (electricity, water, gas, phone, etc.), contact SLCR via the Regional Office emergency phone line and keep them informed of their status. If, for some reason, the facility cannot contact SLCR staff through the regional office phone number, you should contact the hotline. The emergency protocol is located here: Emergency Protocol Handout.

When you call, be prepared to answer to the following:

Facility name

  • Census, including staff assessment of current needs of the residents and monitoring of the ill.
  • Contact person and emergency contact number that is not the facility main line.
  • Has the facility called the fire department and central monitoring company if phones, alarm systems are down?
  • Generator: Y/N
    • If yes, what equipment does the generator serve (fire alarm, HVAC systems)?
    • If yes, amount of fuel onsite and/or system for delivery? How long will fuel last?
    • If no, what is fire watch plan?
    • If no, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner?
      • Obtain generator- is the home set up to receive generator power once delivered? Estimated time for delivery? Estimated time when generator power will be established.
      • Evacuation- Where is facility relocating to, distance from facility, transportation to get there, staffing, sufficient supplies/medications, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner (does the location have a functional emergency generator?) If relocating to a SNF – will the home be over capacity? Is there sufficient beds/space in the receiving facility to house the extra residents?
    • Documentation may be requested, including:
      • If evacuated, a list of residents and were they went
      • Room temperature logs
      • Fire watch documentation

Here are a few things to consider in examining your emergency preparedness plan, specifically as it relates to snow, ice, and power outages.

  • If there is a loss of the primary power, how will the facility ensure adequate temperatures of the facility will be maintained during the emergency situation?
  • Is the plan feasible?
    • Plan for the worst. Most events do not occur on a sunny Tuesday afternoon and the plan should account for things such as poor weather, road conditions, weekends/holidays, evenings, staff ability to travel to work, and other obstacles that may cause issue during the actual emergency.
  • Are staff knowledgeable of the plan and have access to what is needed in order to implement the plan?
    • Phone numbers, contact persons, contracts.
  • Do staff know what to do during an emergency and know who is in charge? If the administrator is not onsite, who is in charge and does that person know all their duties?
    • This may be the DON, but it may also be a charge nurse (or another designated onsite staff) if the event happens in the “middle of the night”. Depending on when the administrator or someone higher up on the order of succession can arrive at the facility, that person (i.e. night charge nurse) may be in charge for an extended amount of time.
  • Is the plan detailed enough?
    • Is there a detailed plan that describes when the residents will evacuate during an emergency? If loss of power, does the plan instruct the staff to start the evacuation prior to the point when the facility is below appropriate air temperatures and to maximize their safety during travel? What is the distance to the emergency evacuation site? What types of roads do they have to traverse, such as “side roads”, bridges, or interstates; all of these roads can have their challenges. Does the facility have more than one contracted emergency site?
      • Is it likely that emergency events will also impact the surrounding areas? It is also possible that the evacuation site may be so far away, residents may not be able to get there when road conditions are less than optimal. Does the contracted site meet all the criteria to allow the residents to shelter in place at that location?
    • Is there a contract for transportation and will that transportation be able to get the residents to and from their current location to the contracted emergency location in a snow/ice storm? If the services have other contracted uses, such as school buses, will they be available at 3:00 P.M. on a school day or can they get drivers at 3:00 A.M. on a Wednesday?
  • Does the facility have a generator?
    • Is there enough fuel, a contract to get more fuel, and a list of what it does and does not operate?
      • Facilities (and the staff in charge) need to know in advance, what their generator will operate. At a minimum, this listing must include whether it runs: Life safety equipment (such as E-lights and fire alarm system(s)), magnetic door locks/door alarms (where applicable for safety), HVAC systems, cooking systems, what outlets residents and staff will be able to be use, and computer equipment/Wi-Fi (if electronic medical records (EMR) are utilized).
      • This list needs to be detailed so staff will know specifically what items will and will not work during a power outage. Many generators will run every second or third ceiling light for emergency lighting, but not all lights in the facility will work during a power outage. This needs to be listed so all staff will know that information.
    • If a facility does not have a generator, what are the plans when it may not be easily able to evacuate due to poor road conditions or other factors that may prohibit a smooth transition from a facility to another location?
      • If the facility plans to have a generator delivered during a loss of power, does the facility have a contract with the generator company to deliver one to them? This contract should include the size of the generator that the facility will need in order to ensure the safety and care needs of the residents are met during the emergency.
        • The building will need to be wired and ready to accept the generator in advance. The facility will not be able to install a generator during the emergency event unless the wiring for the generator has already been completed.
      • Facilities must maintain at least their fire safety equipment (E-lights, fire alarm, sprinkler system, range hood (if any cooking occurs), food, water, heating and cooling, and sewage disposal to shelter in place.
        • There must be a plan of how this will be achieved, emergency supplies, the detailed list of what the generator will run, and any contracts that will be needed during the emergency to ensure these services can continue during the emergency event.
          • Sometimes trucks will not be able to run regular schedules and it may take several days before the facility can get their first delivery after an emergency starts; depending on the extent and severity of the disaster.
        • A power outage may be as simple as a blip, may last for hours, or may last for days – depending on the extent of the power grid damage and when the crews can access the problem(s).
          • The facility needs a plan of when, how, and where they will evacuate if they cannot provide at least the components of the previous bullet point.

During a disaster is the least ideal time to learn an emergency plan will not work or to search for a contracted service. All contracted services including, but not limited to, transportation, fuel needs, evacuation location, food, and water needs to be in the emergency plan. The emergency preparedness team needs to consider and plan all services and contract prior to an actual emergency. During an emergency, it may be very difficult or impossible to get a contracted service due to volume of request, road conditions, and/or other factors.

Thank you for preparing in advance and keeping us informed!

Candida Auris colonization in SNF/LTC

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The QIPMO Multidrug-Resistant Organism (MDRO) Admission Checklist is a practical tool designed to support consistent and safe admission practices for residents with novel or targeted MDROs, including organisms like Candida auris. This checklist outlines key steps for identifying the appropriate precaution type (e.g., droplet, contact, enhanced barrier), communicating with public health and receiving facilities, preparing the resident room, and ensuring environmental hygiene and surveillance/testing processes are in place. It also highlights facility-wide best practices such as auditing hand hygiene, PPE use, and environmental cleaning. Access the checklist can be found here.

Ground Ambulance Reimbursement for BHCC Transports

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Pending Centers for Medicare & Medicaid Services (CMS) approval, effective for dates of service on and after January 1, 2026, the MO HealthNet Division (MHD) will reimburse enrolled ambulance providers for ground transportation from the point of pickup to the nearest appropriate BHCC for participants with a confirmed or suspected mental health and/or substance use disorder diagnosis who are experiencing a behavioral crisis or are presenting for urgent behavioral needs. Please see the attached bulletin for reference.

Applications for Use of Civil Money Penalty Funds

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The State of Missouri is currently accepting applications for use of federal Civil Money Penalty (CMP) Funds. CMPs are imposed by the Centers for Medicare and Medicaid Services (CMS) when long term care facilities are in violation of CMS conditions of participation. Missouri receives a portion of the collected funds to be used to support projects that improve the overall quality of life and/or care of nursing home residents. CMP fund grants are only available for quality improvement initiatives that are outside the scope of normal facility operations and cannot be used to fund goods or services that the applicant already offers or is required to provide by state or federal law or regulation. Because CMPs are only imposed on facilities that are in violation of CMS conditions of participation, applications must benefit nursing home residents residing in these facilities. CMPs cannot be used for state licensed only facilities.

CMP Funds Can Be Used For:

  • Resident or Family Councils
  • Consumer Information
  • Training to Improve Quality of Care
  • Activities to Improve Quality of Life
  • Mental and Behavioral Health
  • Workforce Enhancement
  • Technology Projects

How to Apply:

  • Review the CMP Reinvestment Program (CMPRP) information located on the CMS CMPRP Website, CMPRP Application Resources folder, including the CMPRP Application Handbook, which includes for creating and submitting applications as well as what type of projects are allowable, and the funding available to nursing homes. The application and budget spreadsheet are also included in this folder.
  • Complete the application and budget spreadsheet and submit to slcrcmp@health.mo.gov.
  • Applications must be received by April 1, 2026, to be considered for funding in state fiscal year 2027 (July 1, 2026 – June 30, 2027).

Questions regarding the application process may be sent to slcrcmp@health.mo.gov.

CMS – QSSAM Memo

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QSSAM-26-01-NH Impact of iQIES (Internet Quality Improvement and Evaluation System) Transition on Nursing Home Care Compare

On 1/9/26, CMS issued a QSSAM memo regarding the impact of IQIES on Nursing Home Care Compare Website.

Memorandum Summary

  • CMS recently transitioned to a cloud-based Internet Quality Improvement and Evaluation System (iQIES) for nursing home survey and certification data. This transition has introduced some data discrepancies that may be reflected on Nursing Home Care Compare. Our technical team is actively working to address transition-related differences. Providers should submit specific concerns to BetterCare@cms.hhs.gov.
  • CMS is also evaluating how complaint information is presented on Nursing Home Care Compare. During this evaluation, CMS will be removing the number of complaint allegations and the number of facility reported incidents from Nursing Home Care Compare, beginning February 25, 2026. Information related to official complaint surveys and complaint citations issued as a result of those investigations will continue to be available on Nursing Home Care Compare.

Please see the full memo, QSSAM-25-1-ALL, on CMS’ website.

Certified Nursing Aid Testing Fee Increase

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D&S DIVERSIFIED TECHNOLOGIES (D&SDT) LLP – HEADMASTER, LLP, the third-party test administrator for the Certified Nurse Aide testing has advised DHSS of fee increases effective January 1, 2026.

First time and subsequent retake attempts on the Missouri customized and MODHSS approved Nurse Aide Knowledge test: from $30 to $32.

First time and subsequent retake attempts on the Missouri customized and MODHSS approved Nurse Aide Skill test: from $95 to $103.

COVID-19 Reporting

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Information Related to COVID-19 Reporting:

  • Facilities performing their own COVID-19 testing must report positive results to DHSS unless they are reporting lab tests via the National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.
  • Submitters preferring to send COVID-19 testing records in bulk via HL7 instead of using MODROP should contact the Missouri Data Exchange Team to be onboarded for bulk reporting. This e-mail account is monitored from 8AM-5PM CST Monday-Friday.
  • All entities ordering COVID-19 tests from an external laboratory should enter positive case information into MODROP/ShowMe WorldCare.
  • Requests for new MODROP accounts can be submitted by completing a ShowMe WorldCare Help Desk ticket at https://moexperience.qualtrics.com/jfe/form/SV_737JeAAdftM2q1M.

The original MODROP portal was developed in conjunction with the EpiTrax application. DHSS transitioned from EpiTrax to the ShowMe WorldCare application on August 26, 2024. A new version of MODROP is now available through ShowMe WorldCare: The Missouri Disease Reporting Online Portal (MODROP).

Active users of the earlier version of MODROP were notified of the system transition via the email address linked to their MODROP account. These users were provided with new account credentials prior to the launch of ShowMe WorldCare in August 2024. If an individual needs to utilize MODROP and has not already received this information via email, a new request for an account must be submitted.

Use this link for more information on electronic laboratory reporting and electronic case reporting for reportable conditions: Electronic Laboratory Reporting and Electronic Case Reporting for Reportable Conditions in ShowMe WorldCare.

For the state regulations regarding reporting infectious, contagious, communicable, or dangerous diseases go to Missouri Secretary of State: Code of State Regulations.

DHSS Scam Email Alert

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We have been notified of a scam email circulating, which is impersonating the Missouri Department of Health and Senior Services. The email claims to provide an important update and includes a link to what it describes as a secure message.

Please be extra cautious and do not click on any links or provide any personal information if you receive an email with a subject line similar to “IMPORTANT UPDATE: MISSOURI DEPARTMENT OF HEALTH SERVICES” from an unfamiliar sender. The email may appear legitimate, but it is a fraudulent attempt to deceive recipients and potentially gain unauthorized access to sensitive information.

Our cybersecurity team has been notified, and we are taking the necessary steps to address this issue. In the meantime, if you come across such an email, please delete it.

Show Me Long Term Care Website

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The following message has been posted to the Show Me Long Term Care website.

Important Notice

Due to the transition to the new federal survey and certification system, iQIES (a web-based platform developed by the Centers for Medicare & Medicaid Services (CMS), that manages and evaluates the quality of healthcare services for Medicare and Medicaid beneficiaries), there has been a temporary disruption in the availability of the latest survey and complaint investigation results for certified Skilled Nursing Facilities (SNF) on the Show Me Long Term Care platform as required by RSMo Section 198.528. This disruption does not impact inspection and complaint investigation information for state-licensed only Nursing Facilities (NF) and Intermediate Care Facilities (ICF), Assisted Living Facilities (ALF) and Residential Care Facilities (RCF).

Temporary Solutions

  • While a fix is being developed for the Show Me Long Term Care site, users are advised to visit the Nursing Home Compare website to access the most up-to-date information regarding certified nursing home surveys and complaint investigations.
  • State regulations require long-term care facilities to retain and make available for public inspection at the facility to facility personnel, residents, their next of kin, legal representatives or designees and the general public, a list of names, addresses and occupations of all individuals who have a property interest in the facility as well as a complete copy of each official notification from the Department of Health and Senior Services (the department) of violations, deficiencies, licensure approval, disapprovals, or a combination of these, and responses. This includes, as a minimum, statements of deficiencies, copies of plan(s) of correction, acceptance or rejection notice regarding the plan(s) of corrections and revisit inspection report.
  • Sunshine requests for copies of statements of deficiencies and plans of correction for skilled nursing facility inspections/complaint investigations can also be made at the department’s Sunshine and Records Request website.

Supporting Collaboration Between Behavioral Health Providers and Skilled Nursing Facilities

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The Department of Mental Health has issued a memo to skilled nursing facility providers advising them of opportunities that will be available to individuals with behavioral health conditions through behavioral health providers. Behavioral health providers will be connected with residents who have a qualifying behavioral health condition and been approved for short-term nursing home placement through the Pre-Admission Screening and Resident Review process. For questions related to this memo, please contact Michelle.Clark@dmh.mo.gov.