LTCF December 2023 Updates

Below is important information regarding modifications to the Long-term Care Facility COVID-19/Respiratory Pathogens Module and the COVID-19/Respiratory Pathogens Vaccination Module. The changes described below are now visible within the NHSN application. These updates became effective beginning the week of December 17, 2023. Resources on the NHSN LTCF COVID-19/Respiratory Pathogens Module webpage and the COVID-19/Respiratory Pathogens Vaccination Modules webpage have been updated, where indicated, with revised forms, instructions, FAQs, and CSV templates.

IMPORTANT UPDATES:

Geolocation

The geolocation function is now available within the application. To complete this item, select the icon on the alerts page that is labeled “Facility Geolocation.”

Point of Care (POC) Test Reporting Tool

No enhancements

State Veterans Homes COVID-19 Event Reporting Tool

No enhancements

COVID-19/Respiratory Pathogens Pathway Data Reporting

  • Optional Influenza/RSV Tab
  • NEW! Data reported to the optional Influenza/RSV tab can now be viewed as a report/line list by using the Analysis tab within the application. The analysis function is a tool that can be used to view data reported to NSHN. Please note, reporting to the Influenza/RSV tab is OPTIONAL.

COVlD-19/Respiratory Pathogens Vaccination Influenza and RSV Line List Report for Residents

New! You can now use the Influenza / RSV line listing report to review your facility’s data (or your group’s data) submitted for weekly reporting of Influenza and RSV vaccination rates for residents. These data are included in the line list “Line Listing: All COVID-19 Vaccination Cumulative Summary Data – Residents” found under COVID-19 Module > COVID-19 Vaccination in the analysis tab within the NHSN application.

COVlD-19/Respiratory Pathogens Vaccination Summary Form Changes for Healthcare Personnel

New! Form changes take place 1/1/2024 (Quarter 1, 2024)

  • Questions related to COVID-19 primary series vaccination will be removed
  • The question about HCP being up to date with COVID-19 vaccination (formerly Question #4) is moved up on the form to Question #2
  • Questions 3.1-3.3 will now refer to those who are not up to date in Question #2
  • HCP should not be considered up to date for COVID-19 vaccination unless they received the updated 2023-2024 COVID-19 vaccine

COVlD-19/Respiratory Pathogens Vaccination Trainings

Webinar dates posted below and on the website under the “Announcement Section”

Initial Session

When: January 4, 2024 1:30 PM Eastern Time (US and Canada)
Topic: Updates to Weekly COVID-19 Vaccination Healthcare Personnel Summary Form: Long Term Care Component
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_3CPOEhCYQp-bEXz1JexBaA

Replay Session

When: January 9, 2024 2:30 PM Eastern Time (US and Canada)
Topic: Updates to Weekly COVID-19 Vaccination Healthcare Personnel Summary Form: Long Term Care Component
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_woL3InfGQkKXa8mCK26_-w

Replay Session

When: January 16, 2024 1:30 PM Eastern Time (US and Canada)
Topic: Replay: Updates to Weekly COVID-19 Vaccination Healthcare Personnel Summary Form: Long Term Care Component
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_TZHB8MsHQ0atRx9N3tNRuA#/registration

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

CDC Health Advisory

Please see the CDC Health Alert, entitled, “Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV Immunizations and Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023 – 2024 Winter Season.”

Missouri healthcare providers please contact your local public health agency or the Missouri Department of Health and Senior Services’ (DHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7) with questions regarding this CDC Health Advisory.

NEW Long-Term Care Ombudsman Program Bed and Service Availability Portal

The Covid-19 Long-Term Care Bed Availability portal has been replaced with the Long-Term Care Ombudsman Program Bed and Service Availability portal. Long-Term Care Facilities (all levels of care) are strongly encouraged to complete an electronic survey weekly to report how many beds they have available, and which residents they can serve, i.e., memory care, behavioral health, bariatric, etc. This information will be used to generate a dashboard that is beneficial to facilities, families, hospital discharge planners and the general public to determine bed availability and services throughout the state. More information will be coming soon about how to access and use the dashboard to view all collected data.

This is a great opportunity to share what your facility has to offer!

Please access this link training video for instructions on how to complete the survey. The survey can be accessed from this link: survey. If you have any questions about the survey, please contact the Long-Term Care Ombudsman Program via email LTCOmbudsman@health.mo.gov or call 800-309-3282.

Administration Opens Additional Ordering for COVID-19 Tests

Beginning today, ASPR is refreshing ordering on COVIDTests.gov for every U.S. household to order additional tests at no charge. Households that ordered this fall can order four more tests, and those that have not ordered this fall can submit two orders for a total of eight tests.

Additionally, we continue to provide over four million free COVID-19 tests per week directly to long-term care facilities, schools, community health centers, and food banks. To date, ASPR has distributed over 1.6 billion free COVID-19 tests to the American people through our testing programs, with a focus on access for at-risk populations.

We appreciate your ongoing assistance in reaching the broadest population throughout the country with information about the availability of additional free tests. More information on these efforts and a digital toolkit to share through your social media avenues is available at covidtests.gov.

LTCF October 2023 Post-Release Updates

Below is important information regarding modifications to the Long-term Care Facility COVID-19/Respiratory Pathogens Module and the COVID-19/Respiratory Pathogens Vaccination Module. The changes described below became available beginning the week of October 23, 2023, and are now visible within the NHSN application. Resources on the NHSN LTCF COVID-19/Respiratory Pathogens Module webpage and the COVID-19/Respiratory Pathogens Vaccination Modules webpage have been updated, where indicated, with revised forms, instructions, FAQs, and CSV templates.

Geolocation

Please disregard alerts asking you to confirm your facility’s geolocation. The facility geolocation function located on the ‘Facility Info’ page is not operational at this time.

Point of Care (POC) Test Reporting Tool

No enhancements

State Veterans Homes COVID-19 Event Reporting Tool

No enhancements

COVID-19/Respiratory Pathogens Pathway Data Reporting

New! The LTCF COVID-19 Module was renamed to align with the additional reporting options for Influenza and RSV that became available with the recent NHSN release.

  • The new name: COVID-19/Respiratory Pathogens Module

New! Influenza/RSV Surveillance Tab (optional)

  • The new tab within the LTCF Surveillance Pathways allows LTCF’s to report newly positive resident cases for Influenza and RSV.
  • This newly added tab is OPTIONAL, but highly encouraged!

Influenza/RSV (optional) **NEW DATA TAB**

New! Influenza/RSV Surveillance Tab (optional)

  • Data entry for this tab is OPTIONAL, facilities may choose when and how often data is reported to this tab. However, it is encouraged to report these data on a weekly basis for any facilities choosing to report.
  • If a facility does choose to enter data, information must be entered for both Influenza and RSV in order for the page to save successfully.

The following data elements are collected for Influenza:

  • Newly Positive Tests for Influenza
  • Vaccination Status of Residents with a Newly Confirmed Influenza Test Result
  • Hospitalizations with a Positive Influenza Test
  • Hospitalizations with a Positive Influenza Test and Up to Date

The following data elements are collected for RSV:

  • Newly Positive Tests for RSV
  • Vaccination Status of Residents with a Newly Confirmed RSV Test Result
  • Hospitalizations with a Positive RSV Test
  • Hospitalizations with a Positive RSV Test and Up to Date

Weekly NHSN COVID-19 Vaccination Data Modules

  • New! The LTCF COVID-19 Vaccination Module was renamed to align with the additional reporting options for Influenza and RSV that became available with the recent NHSN release.
  • The new name: COVID-19/Respiratory Pathogens Vaccination Module
  • Continue to report weekly COVID-19 vaccination data per CMS requirements.
  • Reference the COVID-19 Key Terms Document for the most recent definition of Up to Date with COVID-19 vaccination for Quarter 4 of 2023
  • New! Tab added: Influenza/RSV Vaccine Reporting (optional)

Weekly Influenza/RSV Vaccination Reporting for Residents (optional) **NEW DATA TAB**

Reporting Influenza/RSV Vaccines for Residents under this tab is OPTIONAL. If a user opts to enter these data, information can be entered for both Influenza and RSV vaccination or only one.

  • COVID-19 vaccination data for residents must be reported first in order to access Influenza/RSV vaccination reporting tab
  • Report Influenza/RSV data by entering it directly into NHSN application or using the CSV file option
  • The Influenza/RSV vaccination tab is set up for weekly reporting, but these data can be reported at the discretion of the user
  • Influenza/RSV vaccination materials and training slides became available through LTCF COVID-19/Respiratory Pathogens Vaccination website the week of October 23, 2023
  • Person- Level forms for Influenza and RSV will be available in June 2024

Training Slides

Training webinars for the new Influenza/RSV collection tabs for LTCF residents for both the Surveillance Pathways and Vaccination Module were conducted in October 2023. The training slides can be found on the COVID-19/Respiratory Pathogens Module webpage.

Cancellation

The Office hours that were previously scheduled for November 15 regarding Optional Reporting of Influenza and RSV Cases and Vaccinations for Residents of Long-term Care Facilities has been cancelled. Notification will be sent out once this session has been rescheduled.

*Cancelled*
When: Nov 15, 2023, 02:00 PM Eastern Time (US and Canada)
Topic: Office Hours: Optional Reporting of Influenza and RSV Cases and Vaccinations for Residents of Long-term Care Facilities

Reminder: Refresher Trainings on Reporting Annual Healthcare Personnel Influenza Vaccination Data

There will be two refresher trainings for long-term care facilities on reporting annual healthcare personnel influenza vaccination data. The deadline to report these data in the NHSN Healthcare Personnel Safety Component for the 2023-2024 influenza season is May 15, 2024.

The trainings will be held on November 21 and November 28. The content for each webinar is the same. The slides that will be presented during the webinars can be accessed here: Healthcare Personnel Safety Component Healthcare Personnel Vaccination Module Influenza Vaccination Summary Long-Term Care Facilities (cdc.gov).

Webinar registration information is listed below. After registering, you will receive a confirmation e-mail containing information about joining the webinar.

When: Tuesday, November 21, 2023, at 1:00 PM ET
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_PcTHDlv6SC6xyA1VYUEurQ

When: Tuesday, November 28, 2023, at 1:00 PM ET
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_lx1CWu4OSTmUDyuPgoo7AA

Additional training materials pertaining to annual healthcare personnel influenza vaccination data are organized under the “Annual” reporting headings on this webpage: HCP Flu Vaccination | HPS | NHSN | CDC.

LTCF October 2023 Pre-Release Updates

Below is important information regarding modifications to the Long-term Care Facility COVID-19/Respiratory Pathogens Module and the COVID-19/Respiratory Pathogens Vaccination Module. The changes described below will become visible within the NHSN application and will take effect beginning the week of October 23, 2023. Resources on the NHSN LTCF COVID-19/Respiratory Pathogens Module webpage and the COVID-19/Respiratory Pathogens Vaccination Modules webpage will be updated, where indicated, with revised forms, instructions, FAQs, and CSV templates.

Geolocation

Please disregard alerts asking you to confirm your facility’s geolocation. The facility geolocation function located on the ‘Facility Info’ page is not operational at this time.

Point of Care (POC) Test Reporting Tool

No enhancements

State Veterans Homes COVID-19 Event Reporting Tool

No enhancements

COVID-19/Respiratory Pathogens Pathway Data Reporting

New! The LTCF COVID-19 Module will be renamed to align with the additional reporting options for Influenza and RSV that will become available with the upcoming NHSN release.

  • The new name: COVID-19/Respiratory Pathogens Module

New! Influenza/RSV Surveillance Tab (optional)

  • There will be a new tab with the LTCF Surveillance Pathways that will allow LTCF’s to report newly positive resident cases for Influenza and RSV. This newly added tab is OPTIONAL, but highly encouraged!

Influenza/RSV (optional) **NEW DATA TAB**

New! Influenza/RSV Surveillance Tab (optional)

  • Data entry for this tab is OPTIONAL, facilities may choose when and how often data is reported to this tab. However, it is encouraged to report these data on a weekly basis for any facilities choosing to report.
  • If a user does choose to enter data, information must be entered for both Influenza and RSV in order for the page to save successfully.

The following data elements will be collected for Influenza:

  • Newly Positive Tests for Influenza
  • Vaccination Status of Residents with a Newly Confirmed Influenza Test Result
  • Hospitalizations with a Positive Influenza Test
  • Hospitalizations with a Positive Influenza Test and Up to Date

The following data elements will be collected for RSV:

  • Newly Positive Tests for RSV
  • Vaccination Status of Residents with a Newly Confirmed RSV Test Result
  • Hospitalizations with a Positive RSV Test
  • Hospitalizations with a Positive RSV Test and Up to Date

Weekly NHSN COVID-19 Vaccination Data Modules

  • New! The LTCF COVID-19 Vaccination Module will be renamed to align with the additional reporting options for Influenza and RSV that will become available with the upcoming NHSN release.
  • The new name: COVID-19/Respiratory Pathogens Vaccination Module
  • Continue to report weekly COVID-19 vaccination data per CMS requirements.
  • Reference the COVID-19 Key Terms Document for the most recent definition of Up to Date with COVID-19 vaccination for Quarter 4 of 2023.
  • New! Tab added: Influenza/RSV Vaccine Reporting (optional)

Weekly Influenza/RSV Vaccination Reporting for Residents (optional) **NEW DATA TAB**

Reporting Influenza/RSV Vaccines for Residents under this tab is OPTIONAL. If a user opts to enter these data, information can be entered for both Influenza and RSV vaccination or only one.

  • COVID-19 vaccination data for residents must be reported first in order to access Influenza/RSV vaccination reporting tab.
  • Report Influenza/RSV data by entering it directly into NHSN application or using the CSV file option.
  • The Influenza/RSV vaccination tab is set up for weekly reporting, but these data can be reported at the discretion of the user.
  • Influenza/RSV vaccination materials and training slides will be available through LTCF COVID-19/Respiratory Pathogens Vaccination website the week of October 23, 2023.
  • Person level forms for Influenza and RSV will be available in June 2024.

Upcoming Trainings

There will be training webinars for the new Influenza/RSV collection tabs for LTCF residents for both the Surveillance Pathways and Vaccination Module. Registration links as well as the accompanying training slides can be found on the COVID-19/Respiratory Pathogens Module webpage. The registration links are also located below:

When: Nov 15, 2023, 02:00 PM Eastern Time (US and Canada)
Topic: Office Hours: Optional Reporting of Influenza and RSV Cases and Vaccinations for Residents of Long-term Care Facilities (1hr)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_s8SMWxtkS8GrSGn7qiAJbA

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

NHSN-ServiceNow is LIVE

Please use NHSN-ServiceNow to submit questions to the NHSN Help Desk. The new portal can be accessed here or through your SAMS account at. After logging into SAMS, the NHSN-ServiceNow link is located at the bottom of the page.

NHSN-ServiceNow should be used in place of nhsn@cdc.gov, nhsntrain@cdc.gov, and nhsndua@cdc.gov. Users will be authenticated using CDC’s Secure Access Management Services (SAMS), the same way you access NHSN. If you do not have a SAMS login, or are unable to access ServiceNow, you can still email the NHSN Help Desk at nhsn@cdc.gov.

Update – Infection Prevention Toolkits

On September 29, 2023, you received information from the LTC List Serve regarding the Infection Prevention Toolkit that would be delivered to your facility later this month as part of the COVID Prevention and Response Project of the Missouri Department of Health and Senior Services (DHSS). DHSS has entered into an agreement with Concordance Healthcare Solutions to deliver this Infection Prevention Toolkit to your facility with costs being paid by the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project.

Contents of this Infection Prevention Toolkit include:

Pulse Oximeter: Fingertip
Digital Non-Contact Thermometer
3M Fit Testing Kit: BITREX
3M Fit Testing Solution: Saccharin 55 mL Fluid Volume
3M Respirator Wipes: Non-Alcohol
Glo Germ Glo Box Kit with 8oz gel

For those facilities who are in need of Respiratory Fit Testing assistance please contact the Healthcare Associated Infections/Antimicrobial Resistance Program at LTCStrikeTeam@health.mo.gov.

We will be using the administrator’s name and facility address as listed on the DHSS Website https://health.mo.gov/seniors/nursinghomes/licensecert.php as well as the information for the eight hospital based skilled nursing facilities for delivery and contact purposes. Shipment of the Toolkits will begin the week of October 23, 2023.

Phase II of the COVID Prevention and Response Project will focus on working with the facilities in hopes of acquiring needed communication equipment to assist in outbreak control, training and real-time communication with healthcare providers and the Strike Team. In the coming weeks you will receive information on how to order these devices.

Please contact Mary Menges, Project Specialist, at mary.menges@health.mo.gov should you have any questions or concerns regarding with project.

Infection Control Resources Coming Your Way!

Message from the Department of Health and Senior Services Strike Team Project

The Department of Health and Senior Services (DHSS) through the use of the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project funds is embarking upon a multiphase project to assist in COVID prevention and response. All Missouri Skilled Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities and Residential Care Facilities will be a part of this project.

Following models from other states, Phase I of this project will be the delivery of an Infection Prevention Toolkit to all of the above mentioned facilities. This Infection Prevention Toolkit will be delivered at no cost to all of the facilities. Later this fall the Healthcare Associated Infections/Anti-microbial Resistance Program will also be sending out two infection control reference books from the Association for Professional Infection Control and Epidemiology to assist the facilities in infection prevention.

Additional information will be coming in early October on the delivery of the Infection Prevention Toolkits as well as outlining the contents of the Infection Prevention Toolkit and expected date of shipping. Again, this Infection Prevention Toolkit will be delivered to your facility at NO Cost.

The next Phase of this project will be working with the facilities in hopes of acquiring needed communication equipment to assist in outbreak control, training and real-time communication with healthcare providers and the Strike Team. Lastly, we hope to offer the facilities the opportunity to order needed infection and prevention supplies.

Thank you all for your continued efforts to care and protect the citizens of our State.

Upcoming NHSN Surveillance Trainings for LTCFs: 2023-2024 Updated COVID-19 Vaccines and Up to Date Definition

The NHSN Vaccination Team will be hosting multiple webinars to review important changes to the surveillance definition of Up to Date with COVID-19 vaccines for long-term care facilities reporting vaccination data through the NHSN Vaccination Modules.

Key Points:

  • FDA approved updated 2023-2024 COVID-19 vaccines for this fall/winter season. The bivalent vaccines are no longer authorized as of 9/12/2023.
  • CDC recommends everyone aged 5 years and older should get 1 dose of the 2023-2024 updated COVID-19 vaccine to protect against serious illness from COVID-19 and to remain up to date.
  • Under the new recommendations, most individuals will not be up to date with COVID-19 vaccines unless they receive the 2023-2024 updated COVID-19 vaccine.
  • The new definition of up to date with COVID-19 vaccines will apply for NHSN surveillance beginning the week of September 25, 2023 – October 1, 2023 (the first week of reporting Quarter 4 2023).
  • The new definition applies to both the NHSN Weekly HCP and Resident Vaccination Forms and the NHSN COVID-19 Surveillance Pathways (RIFC Form).

Webinar Dates and Registration:

Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: September 25, 2023, 1:00PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN__JGOOXuiSAW1VF2zS-_baw

Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: October 2, 2023, 1:00PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_TDnotOroSbiPut3-2-5RtQ

This Season’s COVID-19 Vaccine Available

Following approval from the Food and Drug Administration (FDA) and a meeting among the Advisory Committee on Immunization Practices, the Centers for Disease Control and Prevention (CDC) has recommended everyone 6 months and older get an updated COVID-19 vaccine to protect against the potentially serious outcomes of COVID-19 illness this fall and winter. Updated COVID-19 vaccines from Pfizer-BioNTech and Moderna will be available in locations throughout Missouri this week.

Those who have not received a COVID-19 vaccine in the past two months can get an updated vaccine for protection this fall and winter.

“Just as in the previous years, the State of Missouri will not require anyone to be vaccinated against COVID-19; that’s not our role,” said Paula F. Nickelson, director of the Missouri Department of Health and Senior Services. “We work to ensure Missourians have access to factual information about the vaccines and access to vaccines themselves if they choose. We encourage each individual to discuss vaccination with their medical provider.”

Vaccination remains the best protection against COVID-19-related hospitalization and death, especially for individuals over age 65 or with weakened immune systems. Vaccination also reduces your chance of suffering the effects of Long COVID, which can develop during or following acute infection and last for an extended duration. 

Most Missourians can still receive a COVID-19 vaccine at no cost. Most health insurance plans will cover COVID-19 vaccine at no cost to the recipient. Individuals who do not have health insurance or with health plans that do not cover the cost can get a free vaccine from local public health agencies, select Federally Qualified Health Centers and pharmacies (including Walgreens and CVS) participating in the CDC’s Bridge Access Program. Children eligible for the Vaccines for Children program also may receive the vaccine from a provider enrolled in that program.

This year marks the first fall and winter virus season where vaccines are available for the three viruses responsible for most hospitalizations – COVID-19, RSV and flu. In addition, DHSS encourages individuals to minimize virus spread by staying home when sick, practicing good handwashing and seeking testing when ill to identify the infection for better protection of one’s family, coworkers and community.

To learn more or to locate a vaccine provider, visit MOStopsCovid.com.

Upcoming NHSN Surveillance Trainings for LTCFs: 2023-2024 Updated COVID-19 Vaccines and Up to Date Definition

The NHSN Vaccination Team will be hosting multiple webinars to review important changes to the surveillance definition of Up to Date with COVID-19 vaccines for long-term care facilities reporting vaccination data and RIFC Pathway data through the NHSN Vaccination and COVID-19 Modules.

Key Points:

  • FDA approved updated 2023-2024 COVID-19 vaccines for this fall/winter season. The bivalent vaccines are no longer authorized as of 9/12/2023.
  • CDC recommends everyone aged 6 months and older should receive the 2023-2024 updated COVID-19 vaccine to protect against serious illness from COVID-19 and to remain up to date.
  • Under the new recommendations, most individuals will not be up to date with COVID-19 vaccines until they receive the 2023-2024 updated COVID-19 vaccine.
  • The new definition of up to date with COVID-19 vaccines will apply for NHSN surveillance beginning the week of September 25, 2023 – October 1, 2023 (the first week of reporting Quarter 4 2023).
  • The new definition applies to both the NHSN Weekly HCP and Resident Vaccination Forms and the NHSN COVID-19 Surveillance Pathways (RIFC Form).

Webinar Dates and Registration:

Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Initial)
When: September 18, 2023, 2:00 PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_YxYp42hwT5KncquBBpLttg

Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: September 22, 2023, 2:00 PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_7bPDRWYETNSf6mnIo6qQvw

Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: September 25, 2023, 1:00PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN__JGOOXuiSAW1VF2zS-_baw

Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: October 2, 2023, 1:00PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_TDnotOroSbiPut3-2-5RtQ

Registration Information for Upcoming Training Webinars

Please register in advance and plan to attend the initial session and/or the replay to learn more about the new updates. After registering, you will receive a confirmation email containing information about joining the webinar. The initial webinar and the webinar replays will cover the same information; therefore, you may only need to attend once but may attend more than one.

The Registration information seen above is also available on LTCF | Weekly HCP & Resident COVID-19 Vaccination |NHSN | CDC

For any questions, please send an e-mail to the NHSN Helpdesk at NHSN@cdc.gov with “COVID-19 Vaccination” in the subject line of the e-mail, along with your facility type.

COVID Rise in LTC Facilities

COVID infections are on the rise in Missouri’s long-term care facilities. A few things to remember…

Follow CDC Guidance:

Skilled Nursing Facilities: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Flong-term-care.html

  • Place a patient with suspected (e.g., those with runny nose, cough, sneeze) or confirmed SARS-CoV-2 infection in a single-person room. The door should be kept closed (if safe to do so). Ideally, the patient should have a dedicated bathroom. If cohorting, only patients with the same respiratory pathogen should be housed in the same room.

Residential Care and Assisted Living may follow community guidance – https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html?CDC_AA_refVal=h

Report Positive Cases

Facilities performing their own COVID-19 testing (antigen testing) must report positive results through one of the following portals:

  1. Missouri Disease Reporting Online Portal (MODROP)
  2. In bulk via HL7 or CSV file using the DHSS- Electronic Lab Reporting process
  3. National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.

Facilities using an external laboratory (PCR testing) must enter positive case information into MODROP.

The Missouri Disease Reporting Online Portal (MODROP). MODROP can be accessed directly from https://modrop.health.mo.gov/ or by using the existing ECD-1 link at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/case-reporting.php and selecting the MODROP button.

NOTE: The recommended browser for use of MODROP is Google Chrome. Other browsers may cause issues with MODROP.

Facilities will need to register for a MODROP account the first time they use the new portal. MODROP allows reporting of only COVID-19 cases. Reports of other reportable conditions may be faxed to 573-751-6417.

If you have any questions or encounter any issues utilizing MODROP or for questions about HL7 or CSV reporting, please reach out to the EpiTrax Help Desk via e-mail at epitrax@health.mo.gov.

Please see the FAQ and thank you for your efforts to provide complete and accurate COVID-19 data to public health.

The ICAR Team Can Help!

QIPMO has formed an Infection Control and Assessment and Response (ICAR) team with a primary goal to assist Missouri Long-Term Care Facilities navigate the challenges of the COVID-19 pandemic and other infectious diseases.

Members of the ICAR Team are available for voluntary, no cost visits (virtual and/or in-person) to any residential care, assisted living, and skilled nursing facility in Missouri. These visits are intended to consultative and collaborative in nature with a non-regulatory focus to evaluate inflection control practices. Visits will consist of:

  • completion of a standardized assessment of infection control processes, focusing on highly-transmittable infectious diseases
  • observations of infection control practices
  • preliminary feedback with supplemental educational resources

See flyer for full details.

Monoclonal Antibody and Oral Antiviral Treatment of COVID in Nursing Homes

The American Medical Association has released information related to use of Monoclonal Antibody and Oral Antiviral Treatment of COVID in Nursing Homes. The study shows that although oral antiviral use has been found to be greater in nursing homes than the community, overall use among nursing home residents has been low and may not be commensurate with residents’ elevated risk. See the attached information from the AMA and this article from US News.

Nursing Homes Used COVID Meds Less Than Expected During Pandemic (usnews.com)

Missouri Nursing Facility Strike Team and Infrastructure Reimbursement Opportunity

On March 1, 2023, the Missouri Department of Health and Senior Services (DHSS) released information about the Missouri Nursing Facility Strike Team and Infrastructure Award, a reimbursement opportunity available to Skilled Nursing Facilities (SNF) and Long Term Care and Other Nursing Facilities (LTC).

Beginning March 1, facility owners and operators may apply for reimbursement for expenses incurred between July 1, 2022 and August 31, 2023, directly related to preparing, preventing, and responding to the COVID-19 pandemic. The intention of this funding is to provide supplemental support to Missouri’s skilled nursing, other long-term care and other nursing facilities during their response to SARS-CoV-2 infections, and also to build and maintain the infection prevention infrastructure necessary to support resident, visitor, and facility healthcare personnel safety. If you operated a Skilled Nursing Facilities or Long Term Care and Other Nursing Facilities licensed with DHSS between July 1, 2022 and August 31, 2023, you are eligible for reimbursement for allowable expenses.

After the application period was opened March 1, 2023, the program was made aware of additional federal administrative requirements that impact the implementation of the program. These requirements do not change the eligibility criteria for facilities or the allowable cost categories but do identify that expenditures for activities that were previously paid or reimbursed by federal funds are not allowed for reimbursement through this award. Only expenses that have not been reimbursed by another federal fund source are allowable for reimbursement from this opportunity.

A very few additional facilities have also been made eligible for this opportunity. This does slightly impact the eligible amount per licensed bed for both skilled nursing facilities (SNF) and long-term care and other nursing facilities (LTC/Other), but the impact is less than a percentage point different in each type of facility.

Facility operators that have already applied for these funds do not need to do anything to adjust their applications, but do need to be aware of the additional guidance and revised amounts, and be prepared to assure that costs submitted for reimbursement meet the federal requirements. DHSS will provide additional information to existing applicants and will advise if any adjustments or additional information are needed on a case-by-case basis.

Updated guidance and eligible amounts are posted on the DHSS website for COVID-19 Health Care Professionals under the heading “Information for Long-Term Care Facilities” at the following link: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php.

All questions should be directed to the DHSS Strike Team via email at LTCStrikeTeam@health.mo.gov.

This program is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award ending May 10, 2024 totaling $14,994,016 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

Post PHE Modifications and Registration Information for the LTCF COVID-19 Module

Below is important information regarding Long-term care facilities (LTCF) and reporting COVID-19 data to NHSN once the Public Health Emergency has ended.

Long-term care facilities that are CMS certified will still need to report to the LTCF COVID-19 Module Surveillance Pathways (Resident Impact and Facility Capacity, Staff and Personnel Impact, and Therapeutics) and the COVID-19 Vaccination Module once the Public Health Emergency is declared over on May 11, 2023

In 2020, CMS published an IFC (CMS-5531-IFC) requiring all LTC facilities to report COVID-19 information using the Centers for Disease Control (CDC), National Healthcare Safety Network (NHSN) (42 CFR 483(g)). This requirement was extended through a final rule (CMS-1747-F) and is set to terminate on December 31, 2024. This excludes the requirements at § 483.80(g)(1)(viii), which will continue to support national efforts to control the spread of COVID-19.

Please note, the COVID-19 Module Surveillance Pathways (Resident Impact and Facility Capacity, Staff and Personnel Impact, and Therapeutics) and the COVID-19 Vaccination Module are two separate modules and data will need to be reported to both on a weekly basis. Reporting to only one module does NOT satisfy the CMS reporting requirements.

NHSN provides a pathway to report data but is not a regulatory or enforcement body. Please direct any questions and/or concerns regarding reporting requirements and penalties/fines to CMS for further information.

The COVID-19 Module Surveillance Pathways will undergo updates in response to the end of the Public Health Emergency, including:

  • Reducing vaccination elements to include only up to date status for residents with a positive COVID-19 test
  • Removal of influenza data field
  • Removal of staffing and supply shortages data fields
  • Removal of deaths in the Staff and Personnel Impact Pathway
  • Removal of the therapeutics pathway
  • Addition of a new data field, hospitalizations, in the Resident Impact and Facility Capacity Pathway to assess relevant outcome data on residents with a positive COVID-19 test.

New Updates to the NHSN LTCF COVID-19 Module Surveillance Pathways Webinars

Specific details regarding these changes will be reviewed during upcoming training webinars.

Registration Information for Upcoming Training Webinars

Please register in advance and plan to attend one of the training sessions to learn more about the new updates. Each webinar will cover the same information; therefore, you may only need to attend once.

When: Thursday, June 1, 2023, 02:00 PM Eastern Time (US and Canada)
Topic: New Updates to the NHSN LTCF COVID-19 Module Surveillance Pathways
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_lQ92SJReSe6gu3RlRbiqaA

When: Wednesday, June 7, 2023, 01:00 PM Eastern Time (US and Canada)
Topic: New Updates to the NHSN LTCF COVID-19 Module Surveillance Pathways
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_WO7zz66lSwyFGUfEx2bU7g

When: Thursday, June 8 & Thursday June 13, 2023, 02:00 PM Eastern time (US & Canada)
Topic: New Updates to the NHSN LTCF COVID-19 Module Surveillance Pathways
Register in advance for this webinar: https://cdc.zoomgov.com/j/1605578239?pwd=TWxwb202WW9tSUpoTi9aVWRNZXBUQT09

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

For questions about any of these updates, please send an e-mail to the NHSN Helpdesk at NHSN@cdc.gov with the subject line identifying the topic of the message.

Important DHSS Update on PPE and Test Kit Supplies

Notice for Non-State Agency Healthcare Partners: The DHSS PPE Warehouse will end distribution of PPE items from the state cache on June 30, 2023.

This change comes as the federal public health emergency comes to end today, May 11, the supply chain has stabilized resulting in adequate stock at suppliers, and COVID cases/outbreaks trend downward. The State of Missouri plans to maintain a PPE cache for future public health emergencies and enhance overall healthcare preparedness. Facilities should prepare for June 30th by working with multiple vendors to procure supplies and maintain adequate stock that accounts for potential order or allocation delays. DHSS will continue to ship COVID antigen test kits and COVID/FLU antigen test kits as requested. For questions related to the end of PPE shipping, please reach out to sns@health.mo.gov.

American Rescue Plan Act (ARPA) Funding Opportunity for RCFs and ALFs

It’s not too late! The Department of Health and Senior Services (DHSS) is still accepting applications for ARPA reimbursement to operators of Residential Care Facilities (RCFs) and Assisted Living Facilities (ALFs) who have not yet applied. Through Missouri’s State Fiscal Recovery Funds, operators may seek reimbursement for expenses incurred between April 1, 2021 and March 31, 2022 that were directly related to preparing, preventing, and responding to the COVID-19 pandemic.

If you operate an RCF or ALF and haven’t already applied for this funding opportunity, please ensure you are registered as a vendor to receive payment from the State of Missouri. Before operators can complete an application for this opportunity, they must register as a vendor with the state’s financial system – SAM II. If the operating entity is already registered as a vendor with the State of Missouri, you do not need to re-register.

The SAM II registration Vendor Input Form can be found at https://oa.mo.gov/sites/default/files/vendor_input_ach_eftd.pdf. The completed Vendor Input Form must be sent directly to the Office of Administration by fax at 573-526-9813 or by mail to Office of Administration/Accounting, PO Box 809, Jefferson City, MO 65102.

Operator Tips in Registering as a Vendor with the State of Missouri:

  • Be sure to register only the legal operating entity and not all individual facilities owned by the same operating entity.
  • Be sure the address used in the State’s financial system is the same address that will be used as the operator’s address on the application and any accounts payable documentation.

Once SAM II registration is submitted, an application for reimbursement must be submitted through the State of Missouri’s American Rescue Plan Act (APRA) Portal located at https://moarpa.mo.gov/. Frequently Asked Questions and an Application Checklist can be found on the “Apply Now” page under the “Operators of Residential Care / Assisted Living Facilities” Grant Program. Requests for additional information about this opportunity should be submitted to LTCARPAReimbursements@health.mo.gov.

Funding for this initiative has been made available through the American Rescue Plan Act (ARPA). Missouri’s ARPA funding opportunities are located here: https://moarpa.mo.gov/available-funding-opportunities/.

Updated CMS Memos Related to COVID-19

CMS released the two memos below this past week. Homes may begin to change their policies and procedures and implement current CDC guidance.

QSO-20-38-NH Testing Expired
QSO-20-39-NH Visitation REVISED

Here is the link to the current CDC guidance for nursing homes: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html#create.

CMS Memo: QSO-23-13-ALL: Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE)

Memorandum Summary

  • Social Security Act Section 1135 emergency waivers for health care providers will terminate with the end of the COVID-19 Public Health Emergency (PHE) on May 11, 2023.
  • Certain regulations or other policies included in Interim Final Rules with Comments (IFCs) will be modified with the ending the PHE. Certain policies, such as the Acute Hospital at Home initiative and telehealth flexibilities have been extended by Congress through December 31, 2024.
  • Long Term Care and Acute and Continuing Care providers are expected to be in compliance with the requirements according to the timeframes listed below {in the memo}.

Please see the full memo for complete details at https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/policy-and-memos-states/guidance-expiration-covid-19-public-health-emergency-phe.

New CMS QI Voices Audio Series Offers Nursing Home Leaders the Facts About COVID-19

Vaccines, Treatments and Promising Practices to Improve Resident Outcomes

CMS QI Voices: Improving COVID-19 Outcomes in Nursing Homes Across America, a new audio series produced by the Centers for Medicare & Medicaid Services (CMS), is available for listening at https://qioprogram.org/cmsqivoices.

This audio series is designed to help busy medical directors, administrators and directors of nursing and education keep residents and staff safe with actionable information to increase COVID-19 vaccination and use of available treatments and improve infection prevention efforts in nursing home and long-term care settings.

In a special series of three 15-minute episodes, CMS Chief Medical Officer Dr. Lee Fleisher leads clinical discussions with experts from the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA) Center for Biologics and Research and the Administration for Strategic Preparedness and Response. These episodes cover:

  • The safety and efficacy of the new bivalent COVID-19 vaccine in long-term care.
  • The benefits, risks and side effects of therapeutics for nursing home residents diagnosed with COVID-19.
  • National programs and partnerships that support nursing homes teams’ efforts to promote COVID-19 infection prevention and vaccination.

In the remaining five-minute episodes, CMS leaders talk with CMS Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and the nursing homes they serve to discuss:

  • How to increase COVID-19 vaccine confidence in care settings with high resident turnover.
  • How one nursing home is using the power of peer ambassadors to increase vaccine confidence.
  • What nursing home staff need to keep doing to help stop the spread of COVID-19.
  • When, who and how to cohort in your nursing home.
  • How a nursing home serving Native American residents uses a culturally inclusive approach to address health equity and increase vaccine confidence.

The CMS QI Voices: Improving COVID-19 Outcomes in Nursing Homes Across America audio series is available wherever listeners have online access. Nursing home teams may listen at https://qioprogram.org/cmsqivoices or contact LTC@hqi.solutions for more information about the audio series.

COMRU Training

COMRU will be hosting a webinar/Q&A session regarding the online process and the ending of the COVID 19 waiver via WebEx.

April 24, 2023: Join Meeting Here
Time: 10:00 a.m.

Join by meeting number
Meeting number (access code): 2460 830 8201
Meeting password: 67tMfa2hU6R

Tap to join from a mobile device (attendees only)
+1-650-479-3207,,24608308201## Call-in toll number (US/Canada)
+1-312-535-8110,,24608308201## United States Toll (Chicago)

Assessment of COVID-19 Outbreaks in Long-Term Care Facilities

The Delta variant quickly became the predominant circulating SARS-CoV-2 strain in the USA during summer 2021. Missouri identified a high number of outbreaks in long-term care facilities (LTCFs) across the state with low vaccination rates among LTCF staff members and poor adherence to mitigation measures within local communities. Ten long-term care facilities in Missouri worked with CDC to evaluate case data to assess disease transmission, vaccination status, and outcomes among residents and staff, including onsite visits to facilities with recent COVID-19 outbreaks in communities with substantial transmission to assess mitigation measures. Attached is a copy of the published findings from that study.

CMS Memo: QSO-23-10-NH: Strengthened Enhanced Enforcement for Infection Control Deficiencies and Quality Improvement Activities in Nursing Homes

Memorandum Summary

  • CMS has rescinded memorandum QSO-20-31-ALL, the Enhanced Enforcement for Infection Control Deficiencies, and replaced it with memorandum QSO-23-10-NH, revised guidance for Strengthened Enhanced Enforcement for Infection Control Deficiencies. This revised guidance strengthens enforcement efforts for noncompliance with infection control deficiencies. The enhanced enforcement actions are more stringent for infection control deficiencies that result in actual harm or immediate jeopardy to residents. In addition, the criteria for enhanced enforcement on infection control deficiencies that result in no resident harm has been expanded to include enforcement on noncompliance with Infection Prevention and Control (F880) combined with COVID-19 Vaccine Immunization Requirements for Residents and Staff (F887).
  • CMS is providing guidance to the State Survey Agencies and CMS locations on handling enforcement cases before and after the revisions of Enhanced Enforcement for Infection Control Deficiencies.
  • Quality Improvement Organizations have been strategically refocused to assist nursing homes in combating COVID-19 through such efforts as education and training, creating action plans based on infection control problem areas, and recommending steps to establish a strong infection control and surveillance program.

Please see the full memo for complete details at https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/policy-and-memos-states/strengthened-enhanced-enforcement-infection-control-deficiencies-and-quality-improvement-activities.