Winter Weather

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

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

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

Facility name

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

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

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

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

Thank you for preparing in advance and keeping us informed!

Ground Ambulance Reimbursement for BHCC Transports

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

CMS – QSSAM Memo

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

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

Memorandum Summary

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

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

Supporting Collaboration Between Behavioral Health Providers and Skilled Nursing Facilities

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

PUBLIC NOTICE

PUBLIC NOTICE: Proposed Rulemaking Comment Period – 19 CSR 30-86.047 Administrative, Personnel, and Resident Care Requirements for Assisted Living Facilities.

The Department of Health and Senior Services, Section for Long Term Care Regulation is soliciting public comments on the proposed rulemaking for 19 CSR 30-86.047 Administrative, Personnel, and Resident Care Requirements for Assisted Living Facilities. The proposed rule is published in the December 1, 2025 Volume 50, Number 23 of the Missouri Register at https://www.sos.mo.gov/CMSImages/AdRules/moreg/2025/v50n23Dec1/v50n23.pdf.

NOTICE OF PUBLIC HEARING AND NOTICE TO SUBMIT COMMENTS: Anyone may file a statement in support of or in opposition to this proposed amendment with Carmen Grover-Slattery, Regulation Unit Manager, Section for Long-Term Care Regulation, PO Box 570, Jefferson City, MO 65102-0570 or at RegulationUnit@health.mo.gov. To be considered, comments must be received within thirty (30) days after publication of this notice in the Missouri Register. A public hearing is scheduled for Jan. 6, 2026, from 1-4 p.m., in the Truman Conference Room located at 920 Wildwood Drive, Jefferson City, MO.

QSO-26-01-ALL REVISED: REVISED: Contingency Plans – State Survey & Certification Activities in the Event of Federal Government Shutdown

QSO-26-01-ALL REVISED: REVISED: Contingency Plans – State Survey & Certification Activities in the Event of Federal Government Shutdown 10.31.2025

Memorandum Summary

Pursuant to the federal government shutdown, we are doing our utmost to:

  • Protect Medicare and Medicaid beneficiaries against immediate dangers to life and health, and
  • Prevent providers and suppliers from experiencing interruptions that would threaten their ability to provide healthcare services that are vital to Medicare and Medicaid beneficiaries.

In this memorandum we identify functions that (a) are not affected by a Federal shutdown, (b) excepted functions that are to be continued in the event of a shutdown (also referred to as “essential functions”), and (c) other activities that are directly affected, are not legally authorized to be performed, and therefore should not be operational during a Federal shutdown.

For full details, please see QSO-26-01-ALL REVISED: REVISED: Contingency Plans – State Survey & Certification Activities in the Event of Federal Government Shutdown.

Federal Shutdown

The Centers for Medicaid and Medicare Services has issued a memo regarding the federal shutdown. Please read through the memo for full details as it describes certain activities that the Department of Health and Senior Services (or their contractors) currently does not have the authority to conduct – including revisits (unless certain circumstances apply), informal dispute resolutions, recertification surveys, and issuance of 2567s for citations that do not allege harm or greater.

https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-regions/contingency-plans-state-survey-certification-activities-event-federal-government-shutdown

Meet the Midwest QIN-QIO

Please join us for a virtual event to meet the Midwest QIN-QIO.

This event will provide an overview of the CMS QIN-QIO 13th Scope of Work structure and highlight new components and differences from the previous SOW.

During this webinar, we will:

  • Review what we offer for providers and what participation means for them
  • Introduce key contacts at the Midwest QIN-QIO
  • Discuss how we can align efforts with existing and potential partner organizations and identify opportunities for collaboration

There will be time available for participants to ask questions and share information.

Partner with K-State: Are you ready to elevate resident voices?

Are you ready to elevate resident voices? Join Kansas State University and the Moving Forward Coalition in piloting an innovative guidebook that prepares nursing home teams to better honor residents’ Goals, Preferences, and Priorities (GPP). After a successful launch in phase one, we’re ready for phase two beginning in October 2025 and seeking dedicated teams that are ready to make a difference!

Your team might be a good fit for this pilot project if…

  • You have a motivated team that is committed to furthering your person-centered care journey.
  • You have strong leadership in the home that values elevating the resident’s voice in all aspects of their daily lives
  • You are ready to invest time upfront for long-term sustainable improvements to your current systems
  • Your team enjoys collaborative work
  • You are able to commit to monthly meetings via Zoom to check-in with the program coordinator
  • You are excited to be part of research that will improve care in nursing homes nationwide

 What does this look like for you?

We’ve designed this pilot to work with your existing systems. Starting in October, you’ll partner with our Program Coordinator through monthly Zoom meetings alongside other homes in the pilot. You’ll receive two one-hour long trainings about important matters that can often be overlooked in long-term care.

Your team leads the way: identify improvement areas that matter to your team, create and work through action plans, and implement changes that fit your home’s unique needs. You’ll also gain access to proven tools and assessment examples from phase one participants.

Your team will work together to create a reasonable timeline for your action plans early on in the program. Implementation of new systems should start in January.

Are you ready to join us? Email Addie at afvanzut@ksu.edu with the name of your home, location, how many residents you serve and your home’s key contact person.

Have any questions? Email Addie at afvanzut@ksu.edu with questions or to set up a time to call.

NOW AVAILABLE: Final MDS 3.0 Item Sets version 1.20.1v3 and Final MDS 3.0 RAI User’s Manual version 1.20.1

The final Minimum Data Set (MDS) 3.0 Item Sets version (v)1.20.1v3 and Item Matrix v1.20.1v3 are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. This final version of the MDS v1.20.1 item sets (v3) will go into effect October 1, 2025.

The final Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) User’s Manual version (v)1.20.1 is now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The MDS 3.0 RAI User’s Manual v1.20.1 will be effective beginning October 1, 2025.

Skilled Nursing Facility Validation Program

The SNF Validation Program is an audit-based program established to assess the accuracy of Minimum Data Set (MDS)-based quality measures used in the SNF Value Based Purchasing (VBP) and Quality Reporting Programs (QRPs). The SNF validation program audits are scheduled to begin in Fall 2025. SNFs selected for audit will be notified through their Internet Quality Improvement and Evaluation System (iQIES) MDS 3.0 Provider Preview Reports folder. The audit notification will contain instructions for documentation submission, the list of sampled residents for which medical charts are being requested and contact information for the contractor conducting the audit. For the FY2025 performance year/FY2027 program year, noncompliance may result in a 2% reduction of a SNF’s Annual Payment Update for the FY2027 SNF QRP program year.

CMS created a SNF Validation Program website which includes resources that can be found at SNF Validation Program.

Centers of Excellence for Behavioral Health – Grant Ending Sept 29, 2025

DHSS has received official word from the Centers of Excellence for Behavioral Health that their grant will end on September 29, 2025. COE-BH is currently working on maintaining access to the site, including resources and trainings (without certificates) for 1 year post end of contract, however no consultations with Amber Jennings will be conducted after September 15, 2025. You are welcome to reach out to Amber until 9/15/25 for consultation at amber.jennings@allianthealth.org.

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 4/1/25 through 6/30/25 is due August 14, 2025. Please submit PBJ data as soon as possible to avoid delays.

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. The following data must be submitted no later than 11:59 p.m. on August 18, 2025:

  • MDS data for 1/1/25 through 3/31/25;
  • NHSN data for COVID-19 Vaccination Coverage Among Healthcare Personnel for 1/1/25 through 3/31/25.

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

Quality Reporting Program: Non-Compliance Letters for FY 2026 APU

CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2024, which will affect their FY 2026 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into facilities’ Non-Compliance Notification folders in the Internet Quality Improvement and Evaluation System (iQIES) for SNFs on July 18, 2025. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 26, 2025.

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

2025 Senior Day at the Missouri State Fair

Join the Missouri Department of Health and Senior Services (DHSS) and the Missouri Area Agencies on Aging (ma4) on Wednesday, August 13th from 9 am to 2:30 pm, in the Mathewson Building on the Missouri State Fairgrounds. Senior Day festivities include FREE BINGO, line dance lessons, a dance contest and much more! The dance contest, open to those aged 55+, has cash prizes for the top three places in each of the categories of Missouri Waltz, Cha Cha, East Coast Swing, Two-Step, and Line Dancing.

For more information, please visit our website at www.health.mo.gov/seniorday.

2025 SLCR Annual Provider Meetings

Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation

 

Meeting Handouts
The Evolving Role of the Nursing Home Medical Director
Person Directed Care – Getting Back to the Basics
Section Update
Enhancing Care – The Role of Long-Term Care Pharmacies in Supporting SNFs, ICFs, ALFs, and RCFs
QAPI – Endurance & Sustainability

 

 

World Elder Abuse Awareness Day – June 15

Support World Elder Abuse Awareness Day on June 15

World Elder Abuse Awareness Day (WEAAD) is commemorated every June 15th to provide an opportunity for communities to promote a better understanding of abuse and neglect of older adults. WEAAD reminds us that elder abuse has implications for all of us. It is a call to action for individuals, organizations, and communities to learn how to identify, address, and prevent elder abuse so we can all do our part to support everyone as they age.

This year, the theme for WEAAD is Building Strong Support for Elders. Visit the WEAAD webpage for more information and how to get involved.

Missouri DHSS Issues Emergency Waiver to Assist Missourians Impacted by Severe Weather

The Missouri Department of Health and Senior Services (DHSS) has issued an emergency waiver to assist Missourians in need of critical prescription medications following the devastating tornadoes and severe weather that struck Missouri on May 16.

The action comes after Governor Mike Kehoe issued Executive Order 25-24 authorizing DHSS to temporarily waive or suspend any statutory or administrative rule under its purview to allow medical professionals to better assist those affected by storms

The provisions of § 195.010-195.100 and their attendant regulations and 195.060, RSMo, are partially waived to allow pharmacists to fill controlled substance prescriptions for patients in disaster-impacted areas without the presentation of a written prescription and if the pharmacist determines within his or her professional judgment that an extended supply is needed to avoid interruptions to patient care.

This will ensure that individuals whose prescriptions or prescription records were lost or destroyed, or whose original prescribing physician is unavailable, can continue to receive needed medications even if the pharmacy has not previously dispensed or refilled the prescription.

View the waiver.

Center for Innovation 2025 Conference

The Center for Innovation (CFI) 2025 Conference will once again bring together The Green House Project and Pioneer Network communities for the 2025 conference in St. Louis, MO, from August 11 to 14, 2025.

With the theme ofMobilize the Movement,” forward-thinking leaders, academics, advocates, caregivers, and elders will gather for three days of education, innovation, inspiration, and collaboration. Registration is Now Open!

SNF QRP CDC Data Submission Deadline Extended

CMS is aware that access to the reporting of the annual National Healthcare Safety Network (NHSN) Influenza Vaccination among Healthcare Personnel data was not available for a short time on May 15th. In response to this circumstance CMS is extending the deadline for reporting this information to the Centers for Disease Control and Prevention NHSN to Friday, May 23, 2025, at 11:59 PM ET.

Note: This extension does NOT apply to Minimum Dat Set (MDS) data.

2025 Older Americans Month

Each May, the Administration for Community Living leads the celebration of Older Americans Month (OAM). The theme for OAM 2025 is Flip the Script on Aging, which focuses on transforming how society perceives, talks about, and approaches aging.

This May, the Department of Health and Senior Services (DHSS) invites everyone to explore the benefits of growing older. No matter the age, it is always possible to honor older adults’ contributions, explore the many opportunities to stay active and engaged as we age, and highlight opportunities for purpose, exploration, and connection that come with aging.

Likewise, DHSS encourages each of you to also take time to celebrate OAM this month. As you make plans to host an event in your local community or become aware of other community events, please share the event information with us so we may add and promote it on our DHSS website, Health.Mo.Gov/oam.

DHSS thanks you for your partnership. Please join us in celebrating OAM as well as recognizing older adults as strong and diverse resources in our local communities!

Ombudsman Annual Report FFY24

The Missouri Office of the State Long-Term Care Ombudsman Program is pleased to present the FFY 2024 Annual Report. The Older Americans Act states the State Ombudsman Office shall independently develop, provide final approval of, and disseminate an annual report as set forth in section 712(h)(1) of the Act (42 U.S.C. 3058g(h)(1).

The annual report contains an analysis of Ombudsman program data, describes problems experience by long-term care residents, recommendations for improvements to quality of care and life, successes of the program and barriers that prevent optimal operation of the program.

Thank you for taking some time to review the annual report and learn more about the important role Ombudsman have in Missouri.

Annual Healthcare Personnel Influenza Vaccination Data Reporting for Long-Term Care Facilities – Due May 15, 2025

Facilities required to report annual healthcare personnel (HCP) influenza vaccination data through NHSN must do so by May 15, 2025 to meet CMS reporting requirements for the 2024-2025 influenza season.

Below is a summary of key information about this requirement.

Which facilities are required to report these data?

  • The Influenza Vaccination Coverage among HCP measure was finalized in the FY 2023 SNF PPS Final Rule which was published in the Federal Register on August 3, 2022. As a result, CMS-certified skilled nursing facilities (SNFs) are required to report annual HCP influenza vaccination summary data through the NHSN Healthcare Personnel Safety (HPS) Component.

What data are submitted?

  • The reporting period for the 2024-2025 influenza season is from October 1, 2024, through March 31, 2025. Facilities are only required to submit one report that covers the entire reporting period by May 15, 2025.

How should facilities submit these data?

  • Facilities must report annual HCP influenza vaccination summary data through the NHSN HPS Component. 

Who can activate the HPS Component?

  • Only the NHSN Facility Administrator (FA) can activate a new component. The FA can then add users including the HPS Component Primary Contact once the component is activated.
  • If the NHSN FA leaves the facility but does not transfer the role of FA to another individual prior to leaving, please complete the NHSN FA Change Request Form: https://www.cdc.gov/nhsn/facadmin/index.html.
  • Please do not deactivate any other NHSN Components, such as the LTCF Component.

How can LTCFs add the HPS Component?

Where can facilities access training materials?

Who do facilities contact with questions?

Please use NHSN-ServiceNow (accessed here) to submit questions to the NHSN Help Desk. 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 e-mail the NHSN Help Desk at nhsn@cdc.gov.

Thank you for your efforts with reporting annual HCP influenza vaccination summary data through NHSN.