Category: COVID

CMS Memo: QSO-22-15-NH & NLTC & LSC

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Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers

  • CMS continues to review the need for existing emergency blanket waivers issued in response to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
  • Over the course of the COVID-19 PHE, skilled nursing facilities/nursing facilities (SNFs/NFs), inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities have developed policies or other practices that we believe mitigates the need for certain waivers.
  • Applicable waivers will remain in effect for hospitals and critical access hospitals (CAH).
  • CMS will end the specified waivers in two groups:
    • 60 days from issuance of this memorandum
    • 30 days from issuance of this memorandum

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/update-covid-19-emergency-declaration-blanket-waivers-specific-providers.

Report Release Webinar: The National Imperative to Improve Nursing Home Quality

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April 6, 2022: The National Imperative to Improve Nursing Home Quality: Report Release Webinar

Join the National Academies of Sciences, Engineering, and Medicine’s Committee on The Quality of Care in Nursing Homes as it discusses the soon to be released report, The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families and Staff.

This new report examines how our nation delivers, finances, regulates, and measures the quality of nursing home care with particular emphasis on challenges that have arisen in light of the COVID-19 pandemic.

A public report release webinar will be held on Wednesday, April 6, 2022 from 10:00 AM to 11:00 AM (Central Time) during which members of the committee will provide an overview of key findings, conclusions, and recommendations, followed by a moderated question and answer period.

HQIN COVID-19 Vaccine Office Hours

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Have You Had Your Weekly Dose?

The Health Quality Innovation Network’s Weekly Dose Office Hours webinar series provides current updates on COVID-19 guidance and vaccine information. As a Medicare Quality Innovation Network – Quality Improvement Organization (QIN-QIO), HQIN is dedicated to helping you increase your vaccination rates.

This forum for vaccine and booster questions features interactive, peer-to-peer collaboration following a brief presentation. Each session includes best practices and innovative idea sharing as well as tips for improving resident and staff safety. Weekly Dose Office Hours are held Wednesdays at 1:00 p.m. CT/2:00 pm. ET. Register for the next Office Hours, as well as upcoming sessions, at this link: https://tinyurl.com/575d66tn.

For a 30-second overview of the Office Hours, watch this brief video: https://tinyurl.com/2p83yhjy.

MANHA’s 2022 Annual Convention

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June 5-8, 2022: Mandatory PPE – People Pride Endurance
Location: Camden on the Lake, Lake Ozark

Missouri Association of Nursing Home Administrators is pleased to invite you to attend our 2022 Annual Convention. This conference is a focus on the Administrators and staff after an unprecedented 2 years. The goal of this conference is to provide meaningful, forward thinking, and real-time education to pave the path forward while acknowledging the past and working through hard topics, together.

CMS Memo: QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements REVISED 03/10/2022

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  • CMS is committed to taking critical steps to ensure America’s healthcare facilities continue to respond effectively to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
  • On August 25, 2020, CMS published an interim final rule with comment period (IFC). This rule establishes Long-Term Care (LTC) Facility Testing Requirements for Staff and Residents. Specifically, facilities are required to test residents and staff, including individuals providing services under arrangement and volunteers, for COVID-19 based on parameters set forth by the HHS Secretary. This memorandum provides guidance for facilities to meet the new requirements.
  • Replaced the term “vaccinated” with “Up-to-date with all recommended COVID-19 vaccine doses” and deleted the term “unvaccinated.”
  • Updated the recommendations for testing individuals within 90 days after recovering from COVID-19.

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

CMS Memo: QSO-20-39-NH: Nursing Home Visitation – COVID-19 REVISED 03/10/2022

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  • CMS is committed to continuing to take critical steps to ensure America’s healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
  • Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE, including the impact of COVID-19 vaccination.
  • Visitation is allowed for all residents at all times.
  • Replaced the term “vaccinated” with “up-to-date with all recommended COVID-19 vaccine doses” and deleted “unvaccinated.”
  • Updated visitor screening and quarantine criteria.

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19-revised.

COVID-19 Reporting Changes

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Effective 2/26/2022, facilities (RCF, ALF, SNF, ICF, and ICF-IID) no longer need to report the aggregate number of residents and staff tested during outbreak testing to the DHSS redcap portal. Below is a chart which outlines current reporting requirements.

 

Reporting Process/Form

System

Purpose/Description

Required?
For Whom?

Time Frame

1

Electronic COVID-19 Case Reporting

REDCap: DHSS

Reporting form for all positive case results, including staff and residents. This includes POC and PCR testing.**

Yes, for all SNF, ICF, RCF, ALF, ICF-IID and Adult Day Care

Within 24 hours of positive result

2

NHSN LTCF COVID-19 Module

Web Portal: Managed by NHSN

NHSN-required fields solely for certified nursing homes (SNF/NFs).

Yes, for all certified SNF/NF. Voluntary for any state licensed only facility (RCF/ALF/Adult Day Care) or ICF-IID.

Weekly, with a preference for submission on the same day each week

3

NHSN Point of Care Laboratory Reporting Tool

Web Portal: NHSN

POC test reporting that includes both positive and negative POC test results (even if potentially a false positive).

Yes, for any facility not reporting to DHSS in Row 4

Within 24 hours of result of POC test

4

Electronic COVID-19 Laboratory Reporting

Secure File Transfer/CSV file: DHSS

POC test reporting that includes both positive and negative POC test results (even if potentially a false positive).

Yes, for any facility not reporting to NHSN in Row 3

Within 24 hours of result of POC test

 

**Effective 2/25/2022, the Electronic COVID-19 Case Reporting System now requires entry of laboratory (testing) information when Positive Test for COVID-19 is selected as the Reason for Reporting. This change will allow for the data to more easily be ingested into Epitrax and readily available to Local Public Health Agencies- reducing follow-up contacts and calls to facilities to obtain the information.

 

#VoicesOfLongCovid Campaign

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DHSS is collaborating with Resolve to Save Lives, an initiative of the global health organization Vital Strategies, to launch their “Voices of Long COVID” campaign throughout Missouri to increase public awareness of the impact of and unknowns associated with Long COVID. Our end goal is to encourage vaccine uptake, particularly among people ages 18-29, so fewer Missourians struggle with the devastating effects of Long COVID.

The “Voices of Long COVID” campaign features testimonials from a diverse group of people ages 18-29 who are suffering from long-term complications of COVID-19 infection. The initiative follows Resolve to Save Lives’ recent national survey, which found that nearly a third of American adults are unaware of Long COVID, and that long-hauler stories can motivate 40% of unvaccinated people to consider getting a COVID-19 vaccine.

“The brave young adults featured in the campaign are sharing their reality in order to help others avoid the harms of COVID infection,” said Dr. Tom Frieden, President and CEO of Resolve to Save Lives (and former CDC director). “Thousands of Americans struggle with Long COVID every day. Their stories are important reminders that vaccination is our best tool to prevent this potentially life-altering condition.”

The campaign shows the real-life stories of three COVID long-haulers who have been battling debilitating health problems over the past year believed to be caused by their original COVID-19 infection:

  • Katelyn Van Dyke, a 20-year-old Mizzou student who got COVID-19 in November 2020 and now has trouble breathing when walking and severe memory loss.
  • Rob Smith, a 22-year-old who used to run five miles a day and now struggles to climb stairs, maintain a healthy social life and manage the uncertainty of his COVID-19 recovery due to ongoing fatigue and brain fog. He shares his story in Spanish and English.
  • Isaiah Smith, a 26-year-old U.S. Air Force veteran, part-time student and essential worker who became infected with COVID-19 in October 2020 and now experiences extreme nausea, chest pain, shortness of breath, dizziness upon standing, heart palpitations and challenges with comprehension.

The patients spotlighted in the campaign want to warn others about the risks of being unvaccinated.

“Long COVID is real, and the struggle goes beyond what you can see,” Van Dyke said. “We don’t know enough about this condition yet, and there’s a good chance all of us know at least one person who is suffering from this. The best way to prevent COVID-19 and long COVID is to get vaccinated.”

“I’ve learned over the course of the past year that you should always value your personal health-this is especially needed among people who are refusing to get vaccinated,” said Rob Smith. “I’ve been trying to educate people about the long-term effects of COVID and the safety of the vaccine. The trade-off between COVID and the vaccine is not even close.”

Isaiah Smith is sharing his long COVID story “because I don’t want anyone else to experience what I’m going through.” He noted that some of his friends are vaccine-hesitant. “I tell them to talk to their doctor about getting the vaccine. They should avoid getting COVID at all costs because at the end of the day, they’re rolling the dice on what happens afterwards-they have no idea what’s going to happen.”

Missouri’s Long COVID webpage is at MOStopsCovid.com/LongHaul. If you would like to share educational materials, they can be found in both English and Spanish at this link.

Included are:

  • Web banners in various sizes
  • Radio ads in both 15- and 30-second spots
  • Videos
    • 15-second videos formatted for YouTube and Tremor
    • 15- and 30-second stories formatted for Facebook, Instagram and Snapchat

State Antigen Testing Supply Portal Re-Opening Soon –

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Please Read Information Below Carefully!

The Missouri Department of Health and Senior Services (DHSS) is pleased to announce that effective Thursday, February 10, 2022 at 8:00 a.m., we are reopening our antigen testing program! As you are aware, due to a nation-wide shortage of antigen tests and issues with receipt of tests from our distributor, it was necessary for us to suspend that program indefinitely in early January. For awareness, although Friday, February 11, 2022 is a state holiday, we will be accepting requests for tests, but no tests will be shipped on that day.

We have subsequently identified two distributors with adequate supply of ACON Flow Flex rapid antigen tests to allow us to reopen our antigen testing program. Information about ACON Flow Flex can be found here.

The transition to this different rapid antigen test requires the establishment of a new state-wide CLIA (although organizations with their own CLIA can continue to use their own) and thus verification of locations of testing and validation of training of all test administrators. Thus, it is not possible to simply transition existing BinaxNOW users to ordering for ACON Flow Flex – all existing users will need to re-apply to receive ACON Flow Flex, take the required training and provide verification of that training, resubmit a test plan inclusive of the infectious waste disposal plan, and provide the locations of testing in order to be approved to receive tests. Note: For organizations using their own CLIA, please be sure to add ACON Flow Flex to your CLIA waiver by contacting the state CLIA program (see additional information below).

New standing physician’s orders specific to ACON Flow Flex have been established for all tests users previously under a DHSS standing physician’s order. These new orders are available at: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php.

The DHSS Rapid Antigen Test Kit Application and Resource web page includes the initial application and a subject index to answer questions we received during the previous distribution of antigen tests. The page also provides information about where to direct specific questions that test users may encounter. If a test user is unsure of where to direct a question, please contact antigentesting@health.mo.gov.

The DHSS Rapid Antigen Test Kit Application and Resource Page for ACON Flow Flex will be open effective 8:00 a.m. on Thursday, February 10, 2022 at: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php.

Thank you for your continued work to fight COVID!

 

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]

Lab/Facility Name:  
Existing CLIA Waived Lab #:  
Lab Director Name:  
Which COVID-19/ SARS-CoV-2 Waived Test system added?
Check [X] all that may apply.

[    ] Abbott BinaxNOW COVID-19 Ag Card
[    ] Acon FlowFlex
[    ] Quidel Sofia 2 SARS-CoV-2 Antigen assay
[    ] Becton Dickinson Veritor™ Plus Antigen test kit
[    ] Abbott ID Now
[    ] OTHER Waived test(s) approved by FDA EUA (specify below):

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 testing personnel for COVID-19 will be provided adequate and documented training
  • All Manufacturer’s Instructions for Use (IFU) will be strictly adhered to

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

Updated CDC Guidance

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On February 2, 2022, CDC updated the following healthcare infection prevention and control (IPC) guidance documents: Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC and Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes | CDC.

Updates were made in these guidance documents to align with prior updates made for healthcare personnel with higher-risk exposures in the Interim Guidance for Managing Healthcare Personnel with SARS-COV-2 Infection or Exposure to SARS-CoV-2, which was released on December 23, 2021.

A review of the updates was given on a recent Clinician Outreach and Communication Activity (COCA) Call, which was recorded and is accessible here: Webinar January 13, 2022 – Updates to CDC’s COVID-19 Quarantine and Isolation Guidelines in Healthcare and Non-healthcare Settings. Additionally, a brief summary of the updates can be found below. Please consult the guidance documents for the full recommendations.

Vaccination status

Use of N-95 respirators

*Please see complete guidance for full personal protective equipment recommendations

  • CDC continues to recommend gown, gloves, eye protection and a NIOSH-approved N95 or equivalent or higher-level respirator when caring for patients known or suspected to be infected with SARS-CoV-2.
  • In counties with substantial to high community transmission, a NIOSH-approved N95 or equivalent or higher-level respirator is also recommended instead of a facemask when caring for patients not known or suspected to have SARS-CoV-2 infection in the following higher-risk situations:
    • All aerosol-generating procedures;
    • Higher-risk surgical procedures;
    • These respirators can also be used by HCP in situations where additional risks for infection are present, such as caring for a patient who is not up to date with all recommended COVID-19 vaccine doses, the patient is not able to wear source control, and the area is poorly ventilated. They may also be used if healthcare-associated SARS-CoV-2 transmission is identified.

 Viral testing

  • CDC continues to emphasize that anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test as soon as possible.
  • Asymptomatic patients with close contact with someone with SARS-CoV-2 infection, regardless of vaccination status, should have a series of two viral tests for SARS-CoV-2 infection.
    • Generally, test immediately (but not earlier than 24 hours after the exposure) and, if negative, again 5-7 days after the exposure.
  • Testing is not generally necessary for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 90 days; however, if tested, an antigen test instead of a nucleic acid amplification test (NAAT) is recommended as some people may remain NAAT positive after they are no longer infectious.

Criteria to end isolation for patients with SARS-CoV-2 infection cared for in a healthcare facility

  • Asymptomatic patients or those with mild to moderate illness and who are not moderately to severely immunocompromised: manage with recommended precautions for 10 days after their symptoms first appeared.
  • Patients with severe to critical illness and who are not moderately to severely immunocompromised: manage with recommended precautions until at least 10 days and up to 20 days have passed since symptoms first appeared.
  • Symptomatic and asymptomatic patients who are moderately to severely immunocompromised: a test-based strategy and (if available) consultation with an infectious disease specialist or other expert is recommended to determine when these patients can be released from isolation.

Quarantine for patients:

  • Empiric use of Transmission-Based Precautions (quarantine) is recommended for patients who have had close contact with someone with SARS-CoV-2 infection if they are not up to date with all recommended COVID-19 vaccine doses. Duration of quarantine is described in the guidance.
  • Quarantine is not generally needed following close contact with someone with SARS-CoV-2 infection for asymptomatic patients who are up to date on all recommended COVID-19 vaccine doses or who have recovered from infection in the prior 90 days. Potential exceptions are described in the guidance.

Visitation

  • Even if they have met community criteria to discontinue isolation or quarantine, visitors should not visit if they have any of the following and have not met the same criteria used to discontinue isolation and quarantine for patients (typically until 10 days after last exposure or onset of symptoms has passed):

1) A positive viral test for SARS-CoV-2,
2) Symptoms of COVID-19, or
3) Close contact with someone with SARS-CoV-2 infection

  • If visitation cannot be postponed the visitor might be subject to additional precautions.

This guidance on infection prevention and control will continue to be refined as additional information becomes available.

New QIPMO Newsletter – February 2022

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The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 9, Issue 2).

In this issue:

  • How Does the Vaccine Work?
  • Regulation Road
  • Hold It! Insulin Administration
  • COVID Isolation Coding
  • ICAR Corner: Hand Hygiene
  • Coagulation and COVID-19
  • Meeting Universal Needs

Please visit QIPMO’s website here for this and other previous newsletters.

NHSN – Reporting Cumulative Vaccination Data on Additional and Booster Doses

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National Healthcare Safety Network Users:

This is a reminder that for weekly COVID-19 vaccination data reporting, you should be reporting cumulative data for Question 5, the number of individuals who have received an additional or booster dose. This means that for each reporting week, you should be reporting the total number of individuals in Question 1 who have ever received an additional or booster dose of COVID-19 vaccine as of that week, since additional/booster doses became available in August 2021. You should not limit reporting to the number of individuals who received new additional/booster doses of COVID-19 vaccine during that reporting week.

To accurately report cumulative COVID-19 vaccination data for a reporting week, you should first report the total number of individuals at the facility for that week (Question 1).

  • For Question 2 (primary vaccination series): Of the individuals reported in question #1, report the number of individuals who have ever received COVID-19 vaccination (at that facility or elsewhere) since it became available in December 2020.
  • For Question 5 (additional/booster doses): Of the individuals reported in question #1, report the number of individuals who have ever received an additional or booster dose (at that facility or elsewhere) since August 2021.

For additional guidance on how to report cumulative data, please see the following Quick Learn demonstration, posted on the NHSN Vaccination website at: Reporting Weekly Cumulative COVID-19 Vaccination Data (cdc.gov).

We appreciate your time and effort reporting COVID-19 vaccination data in NHSN. Please contact NHSN@cdc.gov with “COVID-19 Vaccination” in the subject line with any additional questions or concerns.

FDA Authorized BinaxNOW Expiry Extension

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The Food and Drug Administration (FDA) has authorized an expiry extension for BinaxNOW tests for three months from the current expiration date listed on the external box. The expiration date to reference is the one on the outside of the box by the hourglass icon. Individual components inside the box will have varying expiration dates, do not pay attention to those dates – only the expiration date on the outside of the box beside the hour glass icon.

Any organizations with tests currently expired are encouraged to check expiration dates as this FDA announcement allows use of expired tests up to three months from current expiration date.

https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas-antigen-diagnostic-tests-sars-cov-2

Below is an attachment from Abbott including the box lot #s that have been extended.
COL-03031 v03 BinaxNOW™ COVID-19 Ag Card Product Expiry Update (002)

Guidance for the Interim Final Rule – Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination

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https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/guidance-interim-final-rule-medicare-and-medicaid-programs-omnibus-covid-19-health-care-staff-1

The guidance in this memorandum specifically applies to the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.

Please read the memo in its entirety. Some key points in the memo:

Within 30 days after the issuance of the memorandum, if a facility demonstrates:

  • Policies and procedures are developed and implemented for ensuring all facility staff, regardless of clinical responsibility or resident contact are vaccinated for COVID-19, including all required components of the policies and procedures specified below (e.g., related to tracking staff vaccinations, documenting medical and religious exemptions, etc.); and
  • 100% of staff have received at least one dose of COVID-19 vaccine or have a pending request for, or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC, the facility is compliant under the rule.

Within 60 days after the issuance of the memorandum if a facility demonstrates:

  • Policies and procedures are developed and implemented for ensuring all facility staff, regardless of clinical responsibility or resident contact are vaccinated for COVID-19, including all required components of the policies and procedures specified below (e.g., related to tracking staff vaccinations, documenting medical and religious exemptions, etc.); and
  • 100% of staff have received the necessary doses to complete the vaccine series (i.e., one dose of a single-dose vaccine or all doses of a multiple vaccine series) or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC, the facility is compliant under the rule.

 Within 90 days and thereafter following issuance of the memorandum, facilities failing to maintain compliance with the 100% standard may be subject to enforcement action.

Visitation in Long-Term Care Facilities (RCF, ALF, ICF and SNFs)

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SLCR has received several questions recently regarding visitation in long-term care facilities. All previous guidance provided by DHSS regarding visitation is no longer in effect. No state waivers are in place regarding regulatory or statutory requirements related to visitation. Section 198.088.6(K), RSMo states, “Each resident admitted to the facility may communicate, associate and meet privately with persons of his choice, unless to do so would infringe upon the rights of other residents.” State regulations also require facilities to follow appropriate infection control procedures. To balance these two requirements, all long-term care facilities (RCF, ALF, ICF and SNF) should follow CDC guidance related to visitors: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html#anchor_1631030962190. The CDC guidance points facilities to CMS’ memo for additional information related to visitation. Certified facilities are required to follow CMS guidelines. Although state licensed only facilities are not required to follow the requirements in QSO 20-39 NH, DHSS highly encourages them to use the memo and FAQs as a standard of practice to ensure safe visitation occurs in their long-term care community.

CMS has developed a Frequently Asked Questions document to address the questions received regarding visitation in Nursing Homes. This additional information is provided to help residents, families and providers ensure that safe visitation can occur. The FAQs can be found on the cms.gov emergencies page here and also in QSO-20-39-NH REVISED.

NHSN Updated COVID-19 Data Tracking Worksheet

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National Healthcare Safety Network Users:

Recently, some NHSN users were unable to use the COVID-19 vaccination data tracking worksheet for surveillance weeks in 2022. The vaccination data tracking worksheets for the COVID-19 Vaccination Modules have been updated, and facilities can now enter data for 2022 in the worksheets. You can find the updated vaccination data tracking worksheets on the following CDC NHSN webpages under the “Data Tracking Worksheets” section:

Long-term care facilities reporting COVID-19 vaccination data on residents and healthcare personnel:
LTC Weekly HCP & Resident COVID-19 Vaccination

Inpatient and dialysis facilities reporting COVID-19 vaccination data on healthcare personnel:
Non-LTC Weekly HCP COVID-19 Vaccination

Dialysis facilities reporting COVID-19 vaccination data on patients:
Dialysis Weekly Patient COVID-19 Vaccination

State Supply of Abbott BinaxNOW Tests

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Missouri has received no new supply from Abbott in the last two weeks and was not notified of a pause from the manufacturer until DHSS inquired this week. All states are experiencing a similar situation, and availability at the state level has been decreasing since the White House announced a federal expansion of at-home testing for Americans. Since then, President Biden announced that hundreds of millions of at-home tests will be made available to Americans in January. With the increase in cases due to high Omicron transmissibility, this issue is being closely monitored as supply and demand changes daily. Missouri is placing a pause on fulfilling re-orders. This pause is due only to the current constrained supply, and we will resume the purchase of antigen tests, once they become available. Our team has identified several options that we are exploring and pursuing now to meet the current testing needs of our existing users as well as the long-term needs.

Effective immediately:

  •         DHSS will not accept new applications from existing test user types. For example, if a facility or organization has not previously received COVID antigen tests – BinaxNOW – through the state warehouse, that facility or organization will not be approved as a new applicant until further notified. We will maintain any new applications received for future potential approval.
  •         Fulfillment of reorders are temporarily being paused until there is clear information regarding the availability of COVID antigen test shipments. DHSS does not know how long this pause may be necessary, but will communicate promptly when the pause is rescinded. This pause was effective with reorders placed 1/3/2022 and subsequently.
  •         During this pause in fulfilment of re-orders, DHSS will prioritize fulfillment of re-orders for any outbreaks. If your facility or organization has a COVID outbreak, please place your reorder and email Kayla.Purnell@health.mo.gov to indicate the outbreak status. To assure prompt processing, please indicate in the e-mail subject line: ‘Outbreak Testing: insert the name of your facility/organization’.

Because the antigen tests are not widely/easily available at this time- you will want to take into consideration creating a testing plan that includes both antigen and PCR testing. The State of Missouri is continuing to reimburse homes for PCR testing related to outbreaks.

 

Reimbursement for OUTBREAK Testing

A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long-Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.

If you have difficulty obtaining swabs and media from your laboratory- you can order them from Missouri State Public Health Laboratory (MSPH). Your contracted laboratory would still process the samples- not MSPH.

State of Missouri (arcgis.com)

CDC Health Advisory: Using Therapeutics to Prevent and Treat COVID-19

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Please see the CDC Health Advisory, number 461, dated 12/31/2021, entitled “Using Therapeutics to Prevent and Treat COVID-19.”

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.

Governor Parson Announces COVID-19 Related State of Emergency to Expire on December 31

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Governor Parson Announces COVID-19 Related State of Emergency to Expire on December 31 | Governor Michael L. Parson (mo.gov)

Governor Parson announced on December 30, 2021 the expiration of Executive Order 21-09 (EO 21-09) that declared a State of Emergency related to COVD-19 on December 31, 2021. Since the outset of this public health emergency, the Governor has exercised a legal means by which we have waived certain statutory and regulatory requirements that could have inhibited the state’s response to the public health emergency. However, with the expiration of EO 21-09, the statutory and regulatory waivers also expire.

For long-term care facilities, there are two waivers that had extended timeframes to allow for compliance.  These two waivers are listed below.

  • Individuals working as nurse aides will have 90 days (until April 1st, 2022) to complete the approved nurse aide training program, as required in Section 198.082.1 and 4, RSMo.
  • Regulation 19 CSR 30-84.010(11)(B)4 had been waived to the extent the provisions require a nurse assistant to perform nurse services for monetary compensation for at least one (1) day in a twenty-four (24) consecutive month time period in order to keep his/her certificate valid. The waiver allowed nurse assistants to provide proof of nursing services after the twenty-four (24) month consecutive period has passed. DHSS will tack on the amount of time the COVID-19 response was ongoing plus two (2) months. Nurse assistants must provide proof of performing nursing services by March 1, 2022 to be in good standing.

UPDATED CDC Guidelines for Isolation/Quarantine

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Facility Employees/Healthcare Personnel

All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to managing healthcare personnel who have tested positive or an exposure to COVID-19.

Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 | CDC

For Certified SNF/ICF providers, current CMS guidance QSO 20-38 states “If COVID-19 is confirmed, staff should follow Centers for Disease Control and Prevention (CDC) guidelines “Criteria for Return to Work for Healthcare Personnel with SARS­CoV2 Infection”, therefore, homes can immediately change policies and procedures to incorporate the updated changes from the CDC.

 

General Population/Visitors

All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to quarantine and isolation for visitors. Facilities should be aware of and follow the updated quarantine/isolation guidelines for visitors in your communities as well.

CDC Updates and Shortens Recommended Isolation and Quarantine Period for General Population | CDC Online Newsroom | CDC

For Certified SNF/ICF providers, current CMS guidance QSO 20-39 states “Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine, should not enter the facility. Facilities should screen all who enter for these visitation exclusions. Homes can immediately change policies and procedures to incorporate the updated changes from the CDC.

COVID Testing Resources

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State Orders for Abbott BinaxNOW Tests

Missouri is experiencing constrained supplies of the BinaxNOW COVID antigen test cards. Thus, effective September 9, 2021, DHSS is implementing a revised BinaxNOW test ordering cadence in order to conserve supply and assure the optimum availability of BinaxNOW COVID antigen tests for all users. Until further notice, please order no more than two weeks supply of BinaxNOW tests for use by your facility or organization. If our supply allows larger quantities to be ordered, we will modify this process accordingly at that time and notify all users. https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php

 

To Reinstate Direct Shipments of Abbott BinaxNOW from the Federal government:

Providers should email their facility information, shipping address and the BinaxNOW delivery Point of Contact for the facility and request to be added back onto the direct shipment list to Binax.Team@hhs.gov. Please be aware reinstatement depends upon available supply of tests to the Federal government and this can take several weeks to begin receiving shipments again.

 

Reimbursement for OUTBREAK Testing

A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long-Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.

Updated Healthcare Worker Isolation and Quarantine Guidance

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The updated guidance for healthcare worker isolation and quarantine guidance has been updated on CDC’s website:

CDC Releases Updated Healthcare Worker Isolation and Quarantine Guidance to Prepare for Anticipated Increase in Omicron Cases

With the growing number of COVID-19 cases from the Omicron variant, and consistent with current understanding of the disease trajectory, CDC is releasing updated guidance (Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2) for isolation and quarantine for healthcare workers, decreasing their isolation time after infection with COVID-19. Additionally, CDC is releasing an update to guidance (Strategies to Mitigate Healthcare Personnel Staffing Shortages) for contingency and crisis management in the setting of significant healthcare worker shortages. These updates provide healthcare facilities with the strategies to limit the effects of staff shortages caused by COVID-19 on patient care and note that:

  • Healthcare workers with COVID-19 who are asymptomatic can return to work after 7 days with a negative test, and that isolation time can be cut further if there are staffing shortages.
  • Healthcare workers who have received all recommended COVID-19 vaccine doses including a booster do not need to quarantine at home following high-risk exposures.

Isolation relates to behavior after a confirmed infection, and quarantine is following exposure to the virus but without a confirmed infection.

These guidelines apply only to the healthcare workforce and may be revised to continue to protect both healthcare workers and patients as additional information on the Omicron variant becomes available to inform recommended actions. Additional information will be published as guidance on CDC’s website soon and shared with healthcare organizations and provider groups. CDC continues to evaluate isolation and quarantine recommendations for the broader population as we learn about the Omicron variant and will update the public as appropriate. CDC strongly encourages COVID-19 vaccination for everyone 5 and older and boosters for everyone 16 and older – vaccination is the best way to protect yourself and our healthcare system from the impact of COVID-19.

The following is attributable to CDC Director, Dr. Rochelle Walensky:

“As the healthcare community prepares for an anticipated surge in patients due to Omicron, CDC is updating our recommendations to reflect what we know about infection and exposure in the context of vaccination and booster doses. Our goal is to keep healthcare personnel and patients safe, and to address and prevent undue burden on our healthcare facilities. Our priority, remains prevention – and I strongly encourage all healthcare personnel to get vaccinated and boosted.”

Nursing Home Visitation Frequently Asked Questions

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CMS has developed a Frequently Asked Questions document to address the questions received regarding visitation in Nursing Homes. This additional information is being provided to help residents, families and providers ensure that safe visitation can occur, especially during the holiday season. The FAQs can be found on the cms.gov emergencies page here and also in QSO-20-39-NH REVISED.

CDC Health Advisory: New SARS-CoV-2 Variant of Concern Identified: Omicron Variant

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Please see the CDC Health Advisory, number 459, dated 12/01/2021, entitled, “New SARS-CoV-2 Variant of Concern Identified: Omicron (B.1.1.529) Variant.”

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.