HQIN Vaccination Campaign

In our continued effort to support the well-being of older adults, the Health Quality Innovation Network (HQIN) has launched a campaign to promote and increase adult vaccinations (including the COVID-19 vaccine) that are proven to lower the risk of illness, hospitalization and death.

The “Your Health Can’t Wait, Vaccinate!” campaign features a variety of free resources to help encourage community members, healthcare providers and older adults to get and stay current with their vaccinations. These resources include social media messaging (images and sample posts), informational pocket cards, customizable letters, sample email signatures and flyers.

Bookmark the HQIN Resource Center and visit often to access the latest additions. New tools are added as information becomes available from nationally recognized agencies and organizations (CDC, ACIP, etc.).

Please join us in spreading the word about lifesaving vaccines. Attached is a sample newsletter article that can be used in electronic or print communications, or even on your organization’s website.

Fit Testing Train-the Trainer Sessions

March 31, 2023: Fitzgibbon Hospital, Marshall
April 12, 2023: Heisinger Bluffs Western Campus, Jefferson City
April 27, 2023: DHSS Regional Office, Poplar Bluff
April 28, 2023: Cape Girardeau Public Library, Cape Girardeau
May 2, 2023: Comfort Inn and Suites, Macon
May 25, 2023: Maranatha Village Community Center, Springfield

Regional Respiratory Fit Testing Train-the-Trainer sessions are being offered throughout Missouri by the Health Quality Innovation Network (HQIN), which is the Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network – Quality Improvement Organization (QIN-QIO) for the state, and the Quality Improvement Program for Missouri (QIPMO) Infection Control and Assessment Response (ICAR) Team. The training is to ensure long-term care facilities have qualified staff to provide respirator fit testing. In addition, the attendee can train others in the proper procedures for fit testing. This training is for qualitative testing using a hood and not quantitative testing.

See flyer for information on Fit Testing Training sessions.

COVID and Flu A/B Test Kits

  • ALERT: DHSS 30-Day Pause of PPE and Test Kit Shipping Operations on January 31, 2023

DHSS will pause shipping operations on January 31, 2023 for up to 30 days to complete inventory and transition warehouse operations to a new platform. Orders for PPE and Flow Flex Antigen Test Kits will need to be placed prior to January 27, 2023 for shipment on January 30, 2023. Please ensure your last order will cover PPE and Antigen Test Kit needs through March 1, 2023. During the pause, orders will not be processed or shipped. However, once shipping resumes March 1, 2023, PPE and Antigen Test Kits will be shipped daily upon approval and order processing.



DHSS is now offering free lifeSign Status COVID-19/Flu A&B Test kits to long-term care facilities.  These testing supplies are currently in limited supply, therefore, LTC facilities should continue to use COVID-19 antigen testing supplies as indicated. Orders may be placed now. Shipping will begin on Tuesday, January 17, 2023.

Application for Status COVID-19/Flu A&B Test Kits

When to use Flow Flex COVID-19 antigen test kit VS Status COVID-19/Flu A&B Test kit:

  1. Use Flow Flex for residents with known COVID-19 exposure
  2. Use Flow Flex for residents during the facility COVID-19 outbreak, or high COVID community level
  3. Use Status test kit if COVID exposure is unknown or unlikely
  4. Use Status test during the facility influenza outbreak, or high influenza activity in the community
  5. Do not use Status test for COVID detection if patient symptomatic for more than 5 days

Long Term Care Facilities must add to the facility’s CLIA certificate:

Adding lifeSign Status COVID-19/Flu A&B Test kits to Your CLIA Test Menu

The CLIA program has developed an email template that you can copy and paste, fill in the blanks, and email to CLIA@health.mo.gov to update your test menu to include lifeSign Status COVID-19/Flu A&B.

Email Subject line: Add COVID-19 Testing to existing CLIA Certificate for [FACILITY NAME]

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
[ X ] OTHER Waived test(s) approved by FDA EUA (specify below): lifeSign Status COVID-19/Flu A&B Test kits

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:

  1. All testing personnel for COVID-19 will be provided adequate and documented training
  2. 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



Reporting Positive Influenza Results

As a reminder, all influenza results must be reported on a weekly basis, in aggregate, to your LPHA using the Laboratory-Confirmed Influenza Weekly Worksheet for Reporters.

For additional information about influenza, including Missouri’s reporting rules, please see https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/pdf/Influenza.pdf or contact MO DHSS, Bureau of Communicable Disease and prevention at (573) 751 -6113.


Reporting Positive COVID-19 Tests

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

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

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

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

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

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

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

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

TB Testing

There has been confusion regarding whether the IGRA (T-SPOT) blood test is acceptable for residents of LTC facilities. There was a revision to state statute 199.290 in 2013 that allows for the use of IGRA for healthcare facility workers. However, a revision was not made to 19 CSR 20.100, which states residents must be tested using the two-step TST.

We received clarification from DCPH that residents can be tested using the IGRA blood test, which is in alignment with CDC guidelines. DCPH staff indicated they are looking at revisions to 19 CSR 20-20.100 but did not give a timeframe on when this might occur. This means IGRA is acceptable for residents and staff. Our TB Flowsheets reflect this on our website (https://health.mo.gov/seniors/nursinghomes/providerinfo.php).

New QIPMO Newsletter – November 2022

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 10, Issue 1).

In this issue:

  • Punching Out Parkinson’s and Other “Therapies”
  • Will the Flu Strike You?
  • Remember Your Why
  • Employee Engagement
  • ICAR Corner

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

Free CE Webinar – Enhanced Barrier Precautions in Nursing Homes

November 15, 2022: Implementation and Use of Enhanced Barrier Precautions in Nursing Homes
Presenters: Abimbola (Bola) Ogundimu, DrPH, RN, CIC, CPHQ; Division of Healthcare Quality Promotion, CDC; Heather Jones, DNP, NP-C; Division of Healthcare Quality Promotion, CDC; and Linda Behan BSN, RN, CIC; Consultant; Long Term Care Infection Prevention, LLC
Moderator: Kara Jacobs Slifka, MD, MPH; Division of Healthcare Quality Promotion, CDC

You are invited to a webinar discussing Enhanced Barrier Precautions in nursing homes. Enhanced Barrier Precautions protect nursing home residents and staff from germs that can cause serious infections and are hard to treat.

Join for a detailed review and discussion about this CDC infection prevention and control recommendation. In addition, hear directly from a long-term care Infection Preventionist about her successes and challenges implementing Enhanced Barrier Precautions in several nursing homes. Presentations will be followed by a conversation with the experts about frequently asked questions from the field.

Infection Prevention & Control in the Long-Term Care Setting: Cleaning and Disinfection

Long-term care (LTC) settings are communities where residents congregate closely in shared spaces, and equipment is used between residents, staff, visitors, and vendors who enter and leave frequently. This makes LTC an ideal environment for germs to spread and risks the lives and well-being of residents and staff.

Proper cleaning and disinfection is crucial to preventing and controlling the spread of any infection. Like many processes, cleaning and disinfection must be done correctly to be effective. This resource will provide all staff in the long-term care setting with information to help them understand and perform the steps required to clean and disinfect properly.

MANHA’s 2022 Annual Convention

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.

Updated CDC Guidance on Antigen Testing in Long Term Care Facilities

The Centers for Disease Control and Prevention (CDC) recently updated the following healthcare Infection, Prevention and Control (IPC) guidance document: SARS-CoV-2 Antigen Testing in Long Term Care Facilities | CDC. The core recommendations in this guidance have not significantly changed. The page was updated to:

Updated CDC Guidance

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.


  • 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.

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

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.

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

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.

UPDATED CDC Guidelines for Isolation/Quarantine

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

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/.

Missouri Nursing Home Advisory Council – Infection Preventionist Roadmap Series

Missouri Nursing Home Advisory Council has created another installment in their Infection Preventionist Roadmap Series for long-term care facilities. As we continue with our “IP Tip Sheets” to support the Infection Preventionist (IP) in their central role of leading the Infection Prevention & Control Program, we shift our focus to linen management. This sometimes-overlooked area of infection control can leave a facility vulnerable to an infection source. Having good procedures and policies in place that include infection control protocols is key to a successful linen management program.

Please see the Nursing Home Advisory Council IP Tip Sheet 4th Edition.

New QIPMO Newsletter – November 2021

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 9, Issue 1).

In this issue:

  • 5-Star Staff
  • Tube Feeding Monitoring
  • Giving Thanks
  • Accounts Payable
  • Red Light, Orange Light, Yellow Light, Blue?
  • More Than a Thousand Words

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

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

Long-Term Care (LTC) Facility COVID-19 Testing Requirements (QSO 20-38-NH, revised 9/10/2021)

Please read the memo carefully. CMS has revised testing requirements for nursing homes including testing of symptomatic residents and staff, and routine testing of staff. Two major changes are:

  • Facilities now have two options to conduct outbreak testing, through either a contact tracing or broad-based testing approach. See Table 1.
  • Routine staff testing is now based on the facility’s county level of community transmission instead of county test positivity rate. The link to determine county level of community transmission is in the memo. The frequency of testing has also been updated. See Table 2.


Table 1: Testing Summary

Testing Trigger



Symptomatic individual identified

Staff, vaccinated and unvaccinated, with signs or symptoms must be tested.

Residents, vaccinated and unvaccinated, with signs or symptoms must be tested.

Newly identified COVID- 19 positive staff or resident in a facility that can identify close contacts

Test all staff, vaccinated and   unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual.

Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual.

Newly identified COVID- 19 positive staff or resident in a facility that is unable to identify close contacts

Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility).

Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility).

Routine testing

According to Table 2 below

Not generally recommended


Table 2: Routine Testing Intervals by County COVID-19 Level of Community Transmission

Level of COVID-19 Community


Minimum Testing Frequency of

Unvaccinated Staff+

Low (blue)

Not recommended

Moderate (yellow)

Once a week*

Substantial (orange)

Twice a week*

High (red)

Twice a week*

+Vaccinated staff do not need to be routinely tested.


Please see the full memo for complete details 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.

Advoque Safeguard Issued Respirator User Notice

On September 17, 2021, Advoque Safeguard issued a user notice identifying 6 very small lots of the model SG100 N95 Particulate Filtering Respirator (TC-84A-9284) that require additional sampling for pressure testing. Any individual or organization in possession of any ASG100 product in the 6 lots should isolate the product and contact Advoque Safeguard Quality Control (qc@advoquesafeguard.com).

More information can be found on the NIOSH Manufacturer Notice webpage: https://www.cdc.gov/niosh/npptl/usernotices/noticesmanufact.html under Advoque Safeguard.

Revocation of NIOSH Certification

As of August 13, 2021, any Shanghai Dasheng Health Products Manufacture Co., Ltd. respirator with a NIOSH approval label containing a revoked approval number is no longer NIOSH-approved and cannot be manufactured, assembled, sold, or distributed.

See the link below to find the approval numbers of the respirators that have been de-certified. The approval number starts with TC-84A. If you can’t find this number on the respirator or its packaging, it was never NIOSH approved in the first place and shouldn’t be used, but if it has any of the listed TC numbers in the link below on the respirator itself or its packaging, you should discontinue use immediately and remove from use any that have been distributed.


Infection Control Assessment and Response Project

QIPMO has collaborated with the Missouri Department of Health and Senior Services (DHSS) in response to the novel Coronavirus known as COVID-19. In doing so, QIPMO has formed a new Infection Control Assessment and Response (ICAR) team with a primary goal of assisting Missouri Long-Term Care Facilities to navigate the challenges of the COVID-19 pandemic and other infectious diseases.

Please see the flyer or visit the following QIPMO webpage – https://nursinghomehelp.org/icar-project/.