Category: Events

LeadingAge Webinar Series – Essentials of the LTC Director of Nursing Role Part 2

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March 29, 2023: Essentials of the LTC Director of Nursing Part 2
March 30, 2023: Essentials of the LTC Director of Nursing Part 2

LeadingAge Missouri in coordination with LeadingAge Iowa is pleased to announce a virtual series that will take place in three segments over the first half of 2023 that will aid in developing the Director of Nursing (DON) role in nursing homes. Elements of this series will focus on budgeting and quality assurance; survey processes and regulations; and human resources, customer service, and leadership.

Each segment of this series is designed to provide in-depth information and discussion on each topic without taking the series in a sequential order or taking all 3 sections of the series. By making each of the 3 segments standalone, you can better address succession planning by having individuals attend as their nurse leadership skills are identified. An additional section in this series will be added to the events calendar in June.

Dementia Across the Continuum: Exploring Best Practices in Every Setting

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April 28, 2023: Dementia Across the Continuum: Exploring Best Practices in Every Setting
Location: Saint Louis University Campus

The workshop will discuss the benefits of a multidisciplinary approach to maximize functional abilities at each dementia stage and include expert presenters from hospital, home, rehab, and long-term care settings. Learners will gain skills for effective communication strategies as well as a structured and organized approach to identify appropriate interventions across dementia care settings.

Speakers include Dr. Lenise Cummings-Vaughn, a Washington University of St. Louis Physician in the Division of Geriatrics and Associate Medical Director at Parc Provence; Dr. Beth Templin, a Board Certified Geriatric Physical Therapist and founder of HouseFit, an innovative outpatient physical therapy company; Dr. Sarah Pease, Occupational Therapist at Memory Care Home Solutions; Amy Sobrino, Social Worker at Memory Care Home Solutions; and insight and advice from people living with dementia and their care partners on best practices.

Course approval applications are being submitted for six hours of continuing education credit for nursing home administrators, physical therapists, physicians, psychologists, occupational therapists, speech therapists, and social workers.

HQI/ASCP Webinar Invite

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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.

 

CMS Memo: QSO 23-05-NH: Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding, and Posting Citations Under Dispute

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Memorandum Summary

  • Adjusting Quality Measure Ratings: CMS will be conducting audits of schizophrenia coding in the Minimum Data Set data and, based upon the results, adjust the Nursing Home Care Compare quality measure star ratings for facilities whose audits reveal inaccurate coding.
  • Posting Citations Under Dispute: To be more transparent, CMS will now display citations under informal dispute on the Nursing Home Care Compare website.

Please see the full memo for complete details at https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/policy-and-memos-states/updates-nursing-home-care-compare-website-and-five-star-quality-rating-system-adjusting-quality.

Health Education Unit Updates

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The DHSS Health Education Unit is conducting Weekly Instructor Info Webinars/Q&A Meet-Ups. These sessions will be held same day and time each week – Tuesdays at 2:00 p.m.

January 31, 2023: Instructor Info Meet Up Meeting
February 7, 2023: Instructor Info Meet Up Meeting
February 14, 2023: Instructor Info Meet Up Meeting
February 21, 2023: Instructor Info Meet Up Meeting
February 28, 2023: Instructor Info Meet Up Meeting

 

Series of the Month Webinar
February 9, 2023: Regional Test Sites Vs. Closed Test Sites
2:00-3:00 p.m.

Please see the CNA Registry webpage for past meetings and more information.

If you have questions, please call our office at 573-526-5686.

Medicare from Start to Finish

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January 17, 2023: Live Virtual Workshop
March 22, 2023: In-Seat Workshop
July 12, 2023: In-Seat Workshop
September 13, 2023: In-Seat Workshop
November 8, 2023: Live Virtual Workshop

This workshop will review the SNF QRP reports from CASPER that provides information about the Medicare Part A stays in your SNF. It will also explore factors impacting SNF PPS assessment schedule, PDPM basics, and consolidating billing that can impact the financial facet of the facility. It also explains Medicare eligibility, coverage, and skilling criteria. The completion of the MDS is becoming more difficult and confusing, this workshop will help clear up the confusion surrounding this process. This workshop is geared towards those individuals working in long‐term care who have a leadership role such as ADM, DON, ADON, or MDS Coordinator.

Free Mental Health Education

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January 19, 2023 (1:00 p.m.): Registration
January 26, 2023 (9:30 a.m.): Registration

Tools of Choice is an evidence-based program focused on the implementation of universal positive practices. This two-hour introductory training is open to community members, parents, and professionals. It covers key concepts of the Tools of Choice curriculum such as: What is behavior, building positive relationships, and how to increase desirable behavior. Join the Positive Support Consultants in learning strategies to make positive change by implementing universal positive practices. Information presented at each training will be the same and is being offered two different dates for convenience.

Presenter: Kathleen Deppeler, Director of Positive Supports
Target Audience: Anyone interested in learning more about Tools of Choice

Action Pact – Conversations with Carmen

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January 20, 2023: Back to Food = Love, Life, Health and Wellbeing = Compliance and Culture Change

This is the first in the 2023 series, Back to the Future: Moving Dining Forward.

From token to true choice, using regulations and standards to help people living in long-term care to eat what they want to eat, and to live the lives they want to live.

Come out of the pandemic better. Take advantage of this time and do it different. Learn how to shift your culture to honor each individual and get back to normal, to HOME, particularly in all things dining and vibrant daily living.

Each webinar will be framed by culture change practices, the Dining Practice Standards, leaning into CMS requirements and the Artifacts of Culture Change 2.0, the domains of wellbeing embedded in the CMS RoPs, and Kitwood’s basic human needs.

RAI Process from Start to Finish

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February 7-8, 2023: Live Virtual Workshop
April 4-5, 2023: In-Seat Workshop
August 8-9, 2023: In-Seat Workshop
October 17-18, 2023: In-Seat Workshop
December 5-6, 2023: Live Virtual Workshop

This workshop will look at the RAI process from beginning to end and at each item of the MDS. The MDS is used for both a clinical and a financial assessment and will discuss the rules on scheduling these assessments and meeting the clinical & financial requirements. This includes a basic understanding of PDPM and how it correlates within the RAI process. This workshop reviews how to gain access to and read the MDS reports from CASPER to self-audit your RAI process and look at your QMs. This workshop is designed for the MDS Coordinator and Care Plan Coordinator, or for the DON or ADM who needs a better understanding of the complexity of the RAI Process.

Virtual MC5 Meeting

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January 17, 2023: Changing the Culture of Aging Through Meaningful Engagement
Presenter: Joan Devine, RN, Former Director of Education, Pioneer Network

Historically as we age, society has told us that our days of contributing are over and it’s time to sit back, relax and become the receiver of care and services. Based on this belief, the goal for many providers of senior services has been to design passive activities, things to keep people busy; to help pass the time. Communities around the country and around the world have heard the voice of Elders, and that voice is telling them that keeping busy is not enough!

It’s about engagement, meaning and purpose, and a chance to contribute to the greater good. What communities are learning is that when Elders are part of a “community commitment”, it not only benefits them and their senior living community, it sends a message that Elders are still valuable members of society.

This virtual session will explore what active engagement looks like based on the principles of the Citizenship Model as well as by the stories of nursing homes and assisted living communities that were recipients of the Pioneer Network’s Community Commitment Awards.

LeadingAge Webinar Series – Essentials of the LTC Director of Nursing Role

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January 18-19, 2023: Essentials of the LTC Director of Nursing Role

LeadingAge Missouri is pleased to offer a joint education with LeadingAge Iowa in a virtual series that will aid in developing the Director of Nursing (DON) role in nursing homes. Elements of this series will focus on budgeting and quality assurance; survey processes and regulations; and human resources, customer service, and leadership.

This is meant to be an ongoing education series and each segment of this series is designed to provide in-depth information and discussion on each topic without taking the series in a sequential order or taking all three sections of the series. By making each of the three segments standalone, you can better address succession planning by having individuals attend as their nurse leadership skills are identified. Additional sections in this series will be added to the events calendar in March and June.

LeadingAge Management Strategies for Workers Compensation in Today’s Long Term Care Environment

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February 15, 2023: Day 1 Registration
February 16, 2023: Day 2 Registration

June 7, 2023: Day 1 Registration
June 8, 2023: Day 2 Registration

August 9, 2023: Day 1 Registration
August 10, 2023: Day 2 Registration

October 11, 2023: Day 1 Registration
October 12, 2023: Day 2 Registration

Learn the elements of Total Safety Management, a comprehensive behavior-based safety program, to reduce employee injury and minimize workers compensation expense. Learn about claims management and the HCFM workers compensation insurance trust.

 

Click on the Zoom link above for both days of the desired session to register.

Financial Planning Webinar for Older Missourians

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January 24, 2023: Financial Planning Webinar for Older Adults

Financial planning is for everyone. This includes taking the steps necessary to ensure that your desires regarding the future of your personal care, medical care, property, and resources are accurately recorded for your loved ones to follow.

Latasha Barnes with Legal Services of Eastern Missouri will discuss how you can use simple estate planning tools to plan for the future.

Health Education Unit Updates

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The DHSS Health Education Unit is conducting Weekly Instructor Info Webinars/Q&A Meet-Ups. These sessions will be held same day and time each week – every Tuesday at 2:00 pm.

Please see the link to join these weekly meetings provided on our CNA Registry webpage (in the announcements towards the bottom of the homepage).

If you have questions, please call our office at 573-526-5686.

Infection Control and Assessment and Response (ICAR)

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

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

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

See flyer for full details.

Follow up to Missouri’s Dental Screening Survey of Older Adults

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The Office of Dental Health conducted a dental screening survey of residents at 22 random long-term care facilities starting in 2020 and ending the summer of 2022. For those 22 long-term care facilities that participated-Thank you for allowing us into your facility in order to gather the necessary information for the dental screenings. We appreciate your willingness to allow us to come and visit your residents, especially after COVID. We know these past few years have been difficult with the pandemic, but we appreciate you working with us for this important information.

Attached is a break-down of what was found in those random nursing homes. While this is not looking at every older adult resident in the state, it is felt it represents a good amount to make assumptions on what would possibly be found if we conducted this screening on every older adult resident. As noted in the attachment, of those older adults with teeth, 40% of them have untreated decay and 29% are in need of periodontal care. The Office of Dental Health has been working with clinics to encourage them to provide care to this underserved population. We will also be developing some training for staff and caregivers on the importance of proper dental care.

Again, thank you for allowing us to conduct this screening. If you have any questions, please contact us at oralhealth@health.mo.gov or 573-751-5874. We wish everyone a safe, enjoyable and healthy holiday season!

FREE Training on Mental Health First Aide

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In-person Adult MHFA Courses:
December 3, 2022 | 9:30a – 5:30p | Doniphan – Register Here
December 7, 2022 | 9:00a – 5:00p | St. Joseph, MO – Register Here
December 12, 2022 | 9:30a – 5:30p | Cape Girardeau – Register Here

In-person Youth MHFA Courses:
December 6, 2022 | 10:00a – 4:30p | Cape Girardeau – Register Here
December 7, 2022 | 8:30a – 3:30p | St. Louis – Register Here

Virtual Adult MHFA Courses:
December 9, 2022 | 8:30a – 3:30p | Virtual – Register Here
December 15, 2022 | 8:30a – 3:30p | Virtual – Register Here

Free trainings sponsored by Missouri’s Department of Mental Health and other sponsors. They are only available to individuals who live or work in Missouri. To find additional courses click here.

MALA Train the Trainer

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January 4, 2023: 2023 Train the Trainer
March 1, 2023: 2023 Train the Trainer
May 10, 2023: 2023 Train the Trainer
July 12, 2023: 2023 Train the Trainer
September 20, 2023: 2023 Train the Trainer
December 6, 2023: 2023 Train the Trainer

Participants must receive approval in order to attend this workshop. Those wishing to attend must submit the application and all other necessary paperwork to MALA at least two weeks prior to the workshop date.

 

2023 MANHA Winterfest

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February 1-3, 2023: Navigating the Storm

Missouri Association of Nursing Home Administrators is pleased to invite you to attend our Winterfest Convention and Trade Show. The goal of this conference is to provide long-term care administrators and their staff practical and inspirational education hours along with the opportunity to network and socialize with colleagues. It is also the only MANHA sponsored conference that provides you a chance to view the latest technology, products, and services offered by suppliers.

Qualified Fire Alarm Inspector/Installer in Certified Facilities

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The fire alarm annual inspection, semi-annual inspection, and repairs must be performed by a qualified individual. Recently, SLCR has observed several instances across the state of unqualified individuals inspecting/repairing fire alarm systems. NFPA states the qualifications needed for the inspector performing these types of services.

NFPA 72, 2010 edition:

10.4.3 Inspection, Testing, and Maintenance Personnel. (SIGTMS)
10.4.3.1* Service personnel shall be qualified and experienced in the inspection, testing, and maintenance of systems addressed within the scope of this Code. Qualified personnel shall include, but not be limited to, one or more of the following:
(1)*Personnel who are factory trained and certified for the specific type and brand of system being serviced
(2)*Personnel who are certified by a nationally recognized certification organization acceptable to the authority having jurisdiction
(3)*Personnel who are registered, licensed, or certified by a state or local authority to perform service on systems addressed within the scope of this Code (The State of Missouri does not have its own certification program, therefore this option is not applicable.)
(4) Personnel who are employed and qualified by an organization listed by a nationally recognized testing laboratory for the servicing of systems within the scope of this Code
10.4.3.2 Evidence of qualifications shall be provided to the authority having jurisdiction upon request.

When completing the LSC portion of the survey, LSC surveyors must verify the inspections and maintenance performed on the fire alarm system(s) were completed and signed off by a qualified person from the listed qualifications in NFPA. The facility is required to provide this certification to the surveyors at the time of the survey. Some companies list the inspector qualifications on the inspection and maintenance reports. These same regulations do not apply to the sprinkler system.

National Institute for Certification in Engineering Technologies (NICET) is not the only option available for certifications, as inspectors can be qualified by other means; however, it is the most common nationally recognized certification. For NICET, the individual must be a Fire Alarm Systems Level II or higher. SLCR staff can search for an individual through the NICET website at: https://nicet.useclarus.com/view/verify/.

Please contact Scott Wiley (573-526-8552 or Scott.Wiley@health.mo.gov) and/or Steven Vest (573-526-8608 or Steven.Vest@health.mo.gov) with any questions regarding the qualifications of fire alarm inspectors.

NHSN Long-Term Care Post-Release October 2022

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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.

  • DxLab COVID-19 Test_ DxLab Inc.
  • MicroGEM Sal6830 SARS-CoV-2 Saliva Test_ MicroGEM U.S., Inc.
  • OHC COVID-19 Antigen Self Test_ OSANG LLC
  • QuickVue At-Home OTC COVID-19 Test_ Quidel Corporation
  • Rapid SARS-CoV-2 Antigen Test Card_ Xiamen Boson Biotech Co., Ltd.

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.

Action Required: iQIES Provider Security Official Recruitment

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As previously announced, CMS is preparing to release the Internet-facing, cloud-based system, referred to as the Internet Quality Improvement and Evaluation System (iQIES) for Minimum Data Set (MDS) submission in early 2023.

Although the MDS submission functionality will not be available immediately, we strongly encourage Provider Security Officials (PSOs) to request access to iQIES as soon as possible, as doing so will allow for a smoother transition prior to the go live date. The individual designated as the PSO must work for the provider and will be responsible for approving or rejecting iQIES user access requests for their respective organizations, including vendors. A user will not be granted access unless a PSO approves the request. The first PSO for your provider will need to be approved by CMS. Once approved, PSOs can approve additional Provider Security Official role requests.

Organizations must complete the steps below to register a Provider Security Official as soon as possible:

 ***IMPORTANT: General user onboarding begins November 15, 2022. At that time, if your organization has not yet successfully registered at least one PSO, users will not be able to complete their access requests. The delay for assigning a PSO places an organization in jeopardy of a smooth transition to iQIES.***

  1. Identify at least one individual who will be the Provider Security Official (PSO). Note: At a minimum, at least one PSO needs to be selected, but CMS highly recommends at least two PSOs are designated so there is a higher likelihood that someone will be available to approve/reject iQIES access requests. The PSO must work for the provider and cannot be a vendor.
  2. Create an account in the HARP system using your corporate email address* at: https://harp.cms.gov/register. Note: HARP User IDs cannot be adjusted. As such, please refrain from using facility names or any special characters (such as # or &) when creating the HARP User ID. *If the facility handles 2 or less providers and does not have a corporate email domain, the PSO may use a personal email address.
  3. Access iQIES at: https://iqies.cms.gov/ and log in with your HARP credentials (completed in step 2 above) to request the Provider Security Official role for YOUR specific provider CMS Certification Number (CCN).
  4. Once the PSO role request has been submitted AND approved, you will receive notification via email. At this point you will be one of the designated PSOs for your CCN and have the authority to approve/reject subsequent requests for access of various role types to your provider’s CCN.

Please see iQIES Quick Reference Guide – Provider Security Official for more information to onboard the PSO Role in iQIES: https://qtso.cms.gov/software/iqies/reference-manuals

Please Note: Currently, we are only onboarding MDS. You do not need to register for a HARP/iQIES account for Payroll Based Journal (PBJ) submissions.

Resources

For more information on HARP or iQIES, please refer to the following resources:

 HARP

 iQIES

If you have questions or require assistance, please contact the iQIES Service Center at iqies@cms.hhs.gov or by phone at (800) 339-9313.

Nursing Home Administrator License Renewals for 2023 and forward

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Administrators due to renew in 2023 and forward are required to complete all required continuing education (CE) clock hours in-seat or can complete a maximum of half of the total required hours through online continuing education programs (web-based, teleconference, self-study and webinar).

Refer to the “License Renewal Checklist” on the website https://health.mo.gov/information/boards/bnha/.

Please contact the Board of Nursing Home Administrators with any questions or concerns at BNHA@health.mo.gov.

COMRU Updates

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Applications Being Deleted

Please ensure all processed online applications and Level 2 screenings have been printed/saved for your records. Facilities (SNFs) will need to have copies of these documents prior to them being deleted.

Processed applications will be deleted from the COMRU online system 60 days after completion.

Additionally, effective November 4, 2022, if a correction has not been resubmitted back to COMRU within 60 days of notification, the online application will be deleted.

COMRU Webinar Training

There will be a webinar/Q&A session regarding the online process on Tuesday, November 15, 2022, 1:00 pm – 2:30 pm.

Join from the meeting link
https://stateofmo.webex.com/stateofmo/j.php?MTID=m2db3a8d7a9ebb09de234b4a6b7672597

Join by meeting number
Meeting number (access code): 2474 027 7616
Meeting password: W4mbfuJ2Hk5

Join by phone
1-650-479-3207 Call-in toll number (US/Canada)
+1-312-535-8110 United States Toll (Chicago)

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

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SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS and NHSN data for 4/1/22 through 6/30/22 must be submitted no later than 11:59 p.m. on November 15, 2022.

The Minimum Data Set (MDS) 3.0 must be transmitted to the Centers for Medicare & Medicaid Services (CMS) through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). Data for the National Healthcare Safety Network (NHSN) measures must be submitted to the Centers for Disease Control and Prevention (CDC). No additional data submission is required for the claims-based measures.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

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.

More information about SNF QRP can be found on the following webpages:
CMS SNF QRP Data Submission Deadlines webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Data-Submission-Deadlines
CMS SNF QRP Help webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-QRP-Help
CMS SNF QRP Measures and Technical Information webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Measures-and-Technical-Information
CMS SNF QRP Training Webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Training