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)
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.
Memorandum Summary
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.
Seminar: Public Health Emergency Ending – What’s Next?
April 6, 2023: Holiday Inn Route 66, St. Louis
April 13, 2023: Courtyard by Marriott, Columbia
April 26, 2023: Stoney Creek Hotel & Conference Center, Independence
The Public Health Emergency (PHE) is scheduled to end as of May 11, 2023. Moving forward it will be essential to apply pandemic lessons learned to maintain and improve processes that will benefit residents/families, staff and facility leadership.
March 31, 2023: Fitzgibbon Hospital, Marshall
April 12, 2023: Heisinger Bluffs Western Campus, Jefferson City
April 27, 2023: DHSS Regional Office, Poplar Bluff
April 28, 2023: Cape Girardeau Public Library, Cape Girardeau
May 2, 2023: Comfort Inn and Suites, Macon
May 25, 2023: Maranatha Village Community Center, Springfield
Regional Respiratory Fit Testing Train-the-Trainer sessions are being offered throughout Missouri by the Health Quality Innovation Network (HQIN), which is the Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network – Quality Improvement Organization (QIN-QIO) for the state, and the Quality Improvement Program for Missouri (QIPMO) Infection Control and Assessment Response (ICAR) Team. The training is to ensure long-term care facilities have qualified staff to provide respirator fit testing. In addition, the attendee can train others in the proper procedures for fit testing. This training is for qualitative testing using a hood and not quantitative testing.
See flyer for information on Fit Testing Training sessions.
The Missouri Department of Health and Senior Services (DHSS) is excited to announce 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, 2023, 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.
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.
Owner/operator applicant must be registered as a vendor with the State of Missouri prior to submitting an application. If not already registered, visit https://missouribuys.mo.gov/registration. Vendor name and address used in registering as a vendor must be the same vendor name address used on the reimbursement application. Be sure to register only the operating entity and not all individual facilities owned by the same company.
Please see the attached Frequently Asked Questions and Application Checklist documents below.
Missouri Nursing Facility Strike Team and Infrastructure Award FAQ Checklist
Missouri Nursing Facility Strike Team and Infrastructure Award Application
Missouri Nursing Facility Strike Team and Infrastructure Award Eligible Facilities
All questions should be directed to the DHSS Strike Team via email at LTCStrikeTeam@health.mo.gov.
On February 9, the Department of Health and Human Services (HHS) announced the Public Health Emergency (PHE) for COVID-19 will end on May, 11, 2023. COVID-19 remains a significant priority for the Biden-Harris Administration and over the next several months, the Centers for Medicare & Medicaid Services (CMS) will work to ensure a smooth transition. During the PHE, CMS has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure easier access to care during the PHE for health care providers and their beneficiaries.
Some of the flexibilities that were created during the pandemic were recently expanded by the Consolidated Appropriations Act, 2023. Others, while critical during our initial responses to COVID-19, are no longer needed. CMS has made further updates to our CMS Emergencies Page with useful information for providers – specifically around major telehealth and individual waivers – that were initiated during the Public Health Emergency (PHE).
Please reference the following guidance in response to the PHE ending May 11, 2023:
Provider-specific fact sheets about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
CMS COVID-19 Waivers and Flexibilities for Providers include:
Department of Health & Human Services Fact Sheet: https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html
In the coming weeks, CMS will be hosting stakeholder calls and office hours to provide additional information. Please continue to visit the CMS Emergencies Page for continuous updates regarding PHE sunsetting guidance as information becomes available to the public.
With the recent announcement from the White House regarding the official end of the Public Health Emergency on May 11, 2023, the waiver that allowed nursing homes to admit new residents who have not received PASRR Level I screenings and Level II evaluations will terminate on May 11, 2023.
That date is beyond the 60 notice that CMS has previously said would be given to allow states to unwind any COVID related changes to their PASRR program. As such, CMS will expect states to resume the completion of PASRR activities prior to admission as of May 12, 2023.
The PASRR process requires that all applicants admitting to Medicaid-certified nursing facilities be screened for possible serious mental disorders or intellectual disabilities and related conditions. This initial pre-screening is referred to as PASRR Level I, and is completed prior to admission to a nursing facility. A negative Level I screen permits admission to proceed and ends the PASRR process unless a possible serious mental disorder or intellectual disability arises later. A positive Level 1 screen necessitates an in-depth evaluation of the individual by the state-designated authority, known as PASRR Level II, which must be conducted prior to admission to a nursing facility.
Long-term care facilities, hospitals, and other referral agencies should educate admission and discharge planners to this requirement- as it is a return to pre-COVID activities that they may be unfamiliar with.
January 30: The Biden Administration announced its intent to end the COVID-19 national emergency and public health emergency declarations on May 11, 2023. To ensure a smooth transition and help protect the health and well-being of the American people, CMS has taken immediate action to update fact sheets and other supporting resources to prepare for changes that will occur beginning on May 11.
February 9, 2023: Promoting COVID-19 Bivalent Vaccinations for Older Adults Webinar (3:00-4:00 p.m. ET)
Register for the upcoming Communities of Practice webinar focused on promoting COVID-19 bivalent vaccinations for older adults and residents/staff in long-term care settings; speakers will present successful strategies in increasing bivalent booster uptake in their communities.
Moderated by CDC’s State, Tribal, Local, and Territorial (STLT) Task Force.
Featuring presentations from:
Register Now: https://phf-org.zoom.us/webinar/register/WN_5y6WJDbzQduEy5z1exaBxQ
January 31, 2023: Clearing the Path for a Healthy New Year: Improving Bivalent Booster Rates in Long-Term Care
Join a FREE interactive panel discussion with frontline pharmacists and nursing home staff who will discuss effective strategies for improving bivalent COVID-19 vaccine rates in skilled nursing homes. You will have the opportunity to pose questions to these national and frontline leaders.
This session will be led by American Society of Consultant Pharmacists (ASCP) Chief Executive Chad Worz, PharmD, BCGP, FASCP and Health Quality Innovators (HQI) Vice President and Senior Consulting Manager Sheila McLean, MBA, LNHA, CPHQ.
We invite nursing home administrators, directors of nursing, infection preventionists and pharmacists to join this session to learn new tactics and workflows that reduce staff stress, and how to improve vaccination rates by building and expanding on already established pharmacy partnerships.
New virus variants are causing significant change in symptoms, and WHO list of COVID symptoms is becoming less relevant. There is a shift to “cold” like presentation without loss of smell/taste, etc. Unfortunately, for older citizens, delirium and psychiatric effects are longer lasting now.
The Division of Community and Public Health shared the attached article from the British Medical Journal for long term care providers to review.
Thank you for your continued partnership in improving the health and well-being of one of our most vulnerable populations.
In line with our efforts to promote COVID vaccinations to nursing home teams and residents, the Centers for Medicare & Medicaid Services (CMS) has released a new audio series. Conversations with the Centers for Medicare & Medicaid Services Chief Medical Officer provides nursing homes with the facts on COVID-19 vaccines and therapeutics that support better resident outcomes. In these conversations with Dr. Lee Fleisher, the CMS CMO, nursing home leaders will hear from Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) experts.
As part of this audio series, titled Quality Improvement (QI) Voices: Improving COVID-19 Outcomes in Nursing Homes Across America, each episode gives listeners a closer look at the projects and the people who are improving health care quality and outcomes. These brief conversations include detailed show notes for even more insights into the process behind health care quality improvement – and how listeners might adapt these to their own organizations.
Three episodes, each under 15 minutes long, have been released: The Facts Behind the Updated COVID-19 Vaccine: Safety and Efficacy, Long-term Care Treatment Options for COVID-19 and CDC Programs for COVID-19 Infection Prevention and Vaccination in Nursing Homes. I encourage you to take full advantage of this cadre of information and resources.
DHSS will pause shipping operations on January 31, 2023 for up to 30 days to complete inventory and transition warehouse operations to a new platform. Orders for PPE and Flow Flex Antigen Test Kits will need to be placed prior to January 27, 2023 for shipment on January 30, 2023. Please ensure your last order will cover PPE and Antigen Test Kit needs through March 1, 2023. During the pause, orders will not be processed or shipped. However, once shipping resumes March 1, 2023, PPE and Antigen Test Kits will be shipped daily upon approval and order processing.
DHSS is now offering free lifeSign Status COVID-19/Flu A&B Test kits to long-term care facilities. These testing supplies are currently in limited supply, therefore, LTC facilities should continue to use COVID-19 antigen testing supplies as indicated. Orders may be placed now. Shipping will begin on Tuesday, January 17, 2023.
Application for Status COVID-19/Flu A&B Test Kits
When to use Flow Flex COVID-19 antigen test kit VS Status COVID-19/Flu A&B Test kit:
Long Term Care Facilities must add to the facility’s CLIA certificate:
Adding lifeSign Status COVID-19/Flu A&B Test kits to Your CLIA Test Menu
The CLIA program has developed an email template that you can copy and paste, fill in the blanks, and email to CLIA@health.mo.gov to update your test menu to include lifeSign Status COVID-19/Flu A&B.
Email Subject line: Add COVID-19 Testing to existing CLIA Certificate for [FACILITY NAME]
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Lab/Facility Name: |
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Existing CLIA Waived Lab #: |
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Lab Director Name: |
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Which COVID-19/ SARS-CoV-2 Waived Test system added? |
[ ] Abbott BinaxNOW COVID-19 Ag Card |
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As the Laboratory Director or administrator/owner’s agent of record for the CLIA facility holding a Waived Certificate identified above, I wish to append my facility’s existing CLIA# to include additional testing for COVID-19. I attest that my facility will provide reasonable assurances that:
All tests results (both positive and negative) will be reported to the proper public health entities under federal and state requirements. See MO DHSS link regarding reporting: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/how-to-report-lab-results.php |
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Reporting Positive Influenza Results
As a reminder, all influenza results must be reported on a weekly basis, in aggregate, to your LPHA using the Laboratory-Confirmed Influenza Weekly Worksheet for Reporters.
For additional information about influenza, including Missouri’s reporting rules, please see https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/pdf/Influenza.pdf or contact MO DHSS, Bureau of Communicable Disease and prevention at (573) 751 -6113.
Reporting Positive COVID-19 Tests
Facilities performing their own COVID-19 testing (antigen testing) must report positive results through one of the following portals:
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.
According to the CDC, older adults are more likely to get very sick from COVID-19. This could mean hospitalization, intensive care, a ventilator to help them breathe, or possibly death. The risk increases as we age and those 85 years and older are the most likely to get very sick.
Our best defense against COVID-19 is vaccination. Vaccines reduce hospitalizations and deaths for those 65 and older. The Health Quality Innovation Network (HQIN) recently launched a campaign to improve vaccination rates among our most vulnerable populations. As part of our Take Aim at a Healthy New Year initiative, we have developed an electronic informational package (below) to help you spread the word about vaccinations and how they can help keep us all healthier.
If you have any questions about this initiative, please contact the HQIN team at 1-877-731-4746 or email LTC@hqi.solutions.
Thank you for your commitment to our shared goals. We wish you a healthy new year!
7 Questions About the COVID Bivalent Vaccine
COVID Vaccine Encouragement Signature and Instructions
COVID Vaccine Social Media Messaging
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:
See flyer for full details.
Long Term Care Facilities
Adult Day Care Programs
Facilities performing their own COVID-19 testing (antigen testing) must report positive results through one of the following portals:
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.
Missouri has limited PPE reserves to assist in filling critical needs and prioritize healthcare providers providing direct care to confirmed or suspected COVID patients. Note requests should only be submitted after all normal supply chains, including the Missouri COVID Supply Solution, have been exhausted and you have a supply of twenty-one days or less on hand as the quantities and types of PPE available through the state are limited.
https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ppe.php
DHSS offers TWO different types of rapid antigen test kits. DHSS offers ACON Flow Flex antigen test kits under the state CLIA waiver for testing in congregate care settings (In-Office) by testing personnel. DHSS also offers iHealth antigen test kits for At-Home testing.
Rapid Antigen Test Kit Application Portal (arcgis.com)
Long Term Care Facilities must make sure the ACON Flow Flex are added to the facility’s CLIA certificate:
Adding ACON Flow Flex to Your CLIA Test Menu
The CLIA program has developed an email template that you can copy and paste, fill in the blanks, and email to CLIA@health.mo.gov to update your test menu to include ACON Flow Flex.
Email Subject line: Add COVID-19 Testing to existing CLIA Certificate for [FACILITY NAME]
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Lab/Facility Name: |
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Existing CLIA Waived Lab #: |
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Lab Director Name: |
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Which COVID-19/ SARS-CoV-2 Waived Test system added? |
[ ] Abbott BinaxNOW COVID-19 Ag Card |
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As the Laboratory Director or administrator/owner’s agent of record for the CLIA facility holding a Waived Certificate identified above, I wish to append my facility’s existing CLIA# to include additional testing for COVID-19. I attest that my facility will provide reasonable assurances that:
All tests results (both positive and negative) will be reported to the proper public health entities under federal and state requirements. See MO DHSS link regarding reporting: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/how-to-report-lab-results.php |
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Memorandum Summary
Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/importance-timely-use-covid-19-therapeutics.
Below is important information regarding modifications to the Point of Care Test Reporting Tool, the Long-term Care Facility COVID-19 Module, and the COVID-19 Vaccination Module. The changes described below took effect with the October 2022, NHSN release. Resources on the NHSN LTCF COVID-19 Module webpage and the COVID-19 Vaccination Modules webpage have been updated, where indicated, with revised forms, instructions, FAQs and CSV templates.
Point of Care (POC) Test Reporting Tool:
The following enhancements were made.
Additional POC devices were added to the NHSN system.
Although some are titled, “At-Home,” the devices below have been provided POC Emergency Use Authorization by the U.S. Food and Drug Administration. If you are using any of these devices, please check the model’s name and ensure you choose the correct device from the drop-down menu.
COVID-19 Pathway Data Reporting:
Please refer to the data reporting pathways below to learn about enhancements that were made within each pathway.
Resident Impact and Facility Capacity Pathway:
No enhancements
Staff and Personnel Impact Pathway:
No enhancements
Supplies and Personal Protective Equipment (PPE) Pathway:
No enhancements
Therapeutics Pathway:
An issue regarding csv upload for group and facility users was recently identified and a resolution has been implemented. Facility and group users are now able to successfully upload csv files.
State Veterans Homes COVID-19 Event Reporting Tool:
No enhancements
Weekly NHSN COVID-19 Vaccination Data Modules
Person-Level COVID-19 Vaccination Forms
If you use the optional Person-Level COVID-19 Vaccination Forms to submit your weekly COVID-19 vaccination data, demographic variables are now required for individuals currently in the facility (i.e., those without an end date or discharge date) to save and submit data. Please keep in mind that if you are unable to obtain this information, you can select ‘Unknown.’
Analysis Reports
The Long-Term Care COVID-19 Vaccination Coverage bar chart reports are once again available for use. These reports are called “Bar Chart – LTC HCP COVID-19 Vaccination Coverage” and “Bar Chart – LTC Resident COVID-19 Vaccination Coverage”.
CMS Reporting Deadline
The deadline for quarterly reporting of COVID-19 vaccination coverage data for long-term care facilities to fulfill CMS Quality Reporting Program requirements covering Quarter 2 of 2022 (April 1, 2022-June 30, 2022) is November 15, 2022.
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.
Memorandum Summary
Please view the latest CMS memo regarding revisions to SSF program at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/revised-guidance-staff-vaccination-requirements.
Please be aware that the upcoming NHSN application update has been pushed back, so the demographics fields (gender, race, and ethnicity) in the Person-Level (Event-Level) COVID-19 Vaccination Forms will not become required for existing records to save and submit data until after the application release, the evening of October 27, 2022.
As a reminder, the demographics fields will only be required for all individuals without an end date or discharge date. These fields will not be required for individuals who are no longer in the facility (i.e., those with an end date or discharge date). Please keep in mind that you may select ‘Unknown’ if you are unable to obtain this information.
Please note that the use of the Person-Level Vaccination Forms remains optional, and facilities are welcome to continue using the aggregate weekly summary forms to submit COVID-19 vaccination data.
New Person-Level Vaccination Form Resources
We are also excited to let you know that two new resources are being posted to the NHSN Long-Term Care Vaccination website by the end of this week:
These new Table of Instructions (TOI) documents can be used to help users enter and manage their person-level vaccination data and contain instructions for each column you see on the Person-Level Vaccination Forms.
Additional NHSN Resources: Person-Level Vaccination Forms
Training:
CSV Materials:
If you have any questions, please reach out to nhsn@cdc.gov and include the subject line “Person-Level Vaccination Forms”. Thank you for your continued efforts to report vaccination data in NHSN.
This message contains reporting deadline reminders for the CMS Quality Reporting Programs. The National Healthcare Safety Network (NHSN) encourages facilities to enter data in timely manner ahead of the deadlines in order to ensure data completion and accuracy. Make sure to allow ample time before the deadline to review, and if necessary, correct your HAI data. Data entered in NHSN after the submission deadline are not sent to CMS and will not be used in CMS pay-for-reporting or pay-for-performance programs. Data can be reviewed by using the Analysis reports within NHSN.
If you are unable to enter data into NHSN, it is possible that your Facility Administrator or Patient Safety Primary Contact has not accepted the updated NHSN Agreement to Participate and Consent. For questions or assistance with the updated Consent form and/or reassignment of the Facility Administrator or Primary Contact, please contact nhsn@cdc.gov as soon as possible.
The following data must be entered into NHSN by November 15, 2022, for facilities that participate in certain CMS quality reporting programs.
Long-Term Acute Care Facilities (LTACs/LTCHs) that participate in the Long-Term Care Hospital Quality Reporting Program:
2022 Quarter 2 (April 1 – June 30) CLABSI and CAUTI data (all bedded inpatient locations)
2022 Quarter 2 (April 1 – June 30) C. difficile LabID Events (FacWideIN, all healthcare-onset, and community-onset)
2022 Quarter 2 (April 1 – June 30) COVID-19 Vaccination Coverage Among Healthcare Personnel
Skilled Nursing Facilities (SNFs) that participate in the Skilled Nursing Facility Quality Reporting Program:
2022 Quarter 2 (April 1 – June 30) COVID-19 Vaccination Coverage Among Healthcare Personnel
Please ensure that at least one individual at your facility can access NHSN via their Secure Access Management Services (SAMS) account and has been assigned appropriate user rights in NHSN to enter and view your facility’s data. To guarantee that your data is accurately entered into NHSN, verify that; 1) your monthly reporting plans are complete; 2) you’ve entered appropriate summary and event data or checked the appropriate no events boxes; and 3) you’ve cleared all alerts from your NHSN facility homepage. For additional guidance on ensuring your data are accurately sent to CMS for Quality Reporting purposes, please visit our website and navigate to the appropriate section(s) for your facility type: https://www.cdc.gov/nhsn/cms/index.html.
If you have any questions, please contact the NHSN Helpdesk: NHSN@cdc.gov. The NHSN Helpdesk is staffed Mondays thru Fridays, 7 am-5 pm ET, excluding Federal Holidays.