The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 12, Issue 4).
In this issue:
- ICAR Corner (Goodbye!)
- The Heat is ON!
- How to Make A Home
- The Age of Electronic Signatures
Category: Long Term Care Blog
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.
CMS Memo Updates
The Focused Infection Control (FIC) survey is retired as of 07-31-2025. Items in the downloads section on the Nursing Home webpage have been updated to align with the revisions to QSO-25-23-ALL.
According to CMS’ website, this also includes QSO 23-10- which contained the requirement for Enhanced Enforcement for Infection Control Deficiencies. EXPIRED: Strengthened Enhanced Enforcement for Infection Control
Additionally, CMS has posted on their website a revision/expiration of QSO-19-07-NH-Enhanced Oversight and Enforcement of Non-Improving Late Adopters/unnecessary psychotropics. EXPIRED: Enhanced Oversight and Enforcement of Non-Improving Late Adopters | CMS
All CMS QSO memos can be found at: Policy & Memos to States and CMS Locations | CMS.
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.
Top Deficiencies Report – 2nd Quarter 2025
Please see the most frequently cited deficiencies report from the first quarter of 2025.
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.
QIPMO RAI Process and MDS 3.0 Webinar Recordings
The QIPMO team is creating webinar recordings about the RAI process and MDS 3.0. It’s still a work in progress, but the Care Planning (Chapter 4 Section) and Medicaid Documentation (Miscellaneous Section) recordings are already available here.
Check back soon – we’re continuing to add more great content and resources to support you and your team!
Health Education Unit News
We are excited to announce that Headmaster D & S has released the NEW option for employers to renew their CNA employee’s certification in TMU.
Just a reminder that it is required that CNAs renew their certification every 24 months to remain active. This new function allows employers to renew through their TMU Employer account, choose their CNA employee, provide the required documentation and pay the renewal fee.
Please see the link below for the “How To” guide: EMPLOYER: How to Renew Employee Certificates.
Don’t have an employer account in TMU???
Fill out the Request to Become Employer application in TMU or contact Headmaster D & S for directions or questions at 888-401-0465.
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.
E4 Center Updated Toolkit
The E4 Center has just updated our Building and Sustaining Effective Behavioral Health Care for Older Adults: Strategies and Considerations toolkit! The new toolkit reflects developments in Medicare coverage of behavioral health services and with further emphasis on select care considerations – check it out!
Specifically, the toolkit revisions incorporate the following updates on Medicare coverage expansions:
- Newly recognized workforces
- Newly covered services
- Newly covered settings
You can access the full 2025 Updated Building and Sustaining Effective Behavioral Health Care for Older Adults: Strategies and Considerations toolkit here.
Additionally, if you’d like more information on these changes, reviewing the E4 Center’s most recent webinar titled, “The Changing Medicate Landscape: What Behavioral Health Providers Need to Know,” presented by Kate Krajci, LCSW and Bonnie Ewald, MA on July 2nd, 2025 is recommended.
Hopefully this toolkit is a useful reference for you in your efforts to build and sustain effective behavioral health care for older adults! Please reach out to us at E4Center@rush.edu with any questions or comments!
Resource Limit/Spenddown Amount
Effective July 1, 2025, the Resource Limit/Spenddown Amount will increase from $5,909.25 to the new amount of $6,068.80. Facilities are required to notify the resident / financial guardian of the need to spend down when the resident reaches $200 less that amount to ensure Medicaid will not be affected.
For more information, please visit https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf.
Feel free to contact Lynn Gilmore, Lead Auditor, at 573-508-4150 if you have any questions.
CMS Memo: QSO-25-19-ALL: Release of CMS-2567: Statement of Deficiencies and Plan of Correction
Memorandum Summary
- CMS is committed to the transparency of quality of care findings, so that patients, residents, and their families can make informed health care decisions.
- The official Form CMS-2567: Statement of Deficiencies and Plan of Correction (CMS-2567) will be publicly releasable within 14 days after receipt by the provider, supplier, or lab. In other words, the CMS-2567 can be immediately released upon receipt by the provider/supplier.
- This update aligns with the Nursing Home CMS-2567 process, which per regulation, are releasable within 14 days of transmission to the facility (See 42 CFR 488.325).
- This guidance does not apply to Accrediting Organization (AO) survey findings, except those related to surveys of Hospice and Home Health Agencies.
Please see the full memo for details located at https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-and-cms-locations/release-cms-2567-statement-deficiencies-and-plan-correction.
Changes to the Pre-Admission Screening and Resident Review (PASRR) Level 2 Process
The Department of Health and Senior Services Central Office Medical Review Unit (COMRU) and the Department of Mental Health (DMH) are pleased to announce changes to the processing of Pre-Admission Screening and Resident Review (PASRR) Level 1 applications that indicate a Level 2 evaluation should be completed – those with serious mental illness and/or intellectual disability/developmental disability related diagnoses. The goal of these changes is to streamline the process and to decrease the review time for these applications.
Currently, Level 1 applications that indicate a Level 2 evaluation are first reviewed by COMRU staff to determine whether the applicant meets Nursing Facility Level of Care (LOC) before the application is sent to the DMH for a Level 2 evaluation by DMH’s contractor, Bock Associates. This review process can take several working days to complete, which may delay the transition to a nursing home.
Effective July 1, 2025, Level 1 applications that indicate a Level 2 evaluation, based on the responses on the application, will be sent to DMH for review and determination of whether a Level 2 evaluation is necessary. The LOC determination will be made after DMH makes the determination on the Level 2 evaluation. DHSS expects to complete the LOC within one business day of the DMH determination.
This change will have no impact to individuals completing applications – there will be no changes to the application or to the submission process.
COMRU does receive several applications that do not indicate a Level 2 evaluation based on the responses on the application, however a review of the application and attachments/supporting documentation shows the application should have indicated a Level 2 evaluation. Often, the individual has already been admitted to a nursing home and payment to the nursing home may be delayed until the Level 2 evaluation is complete. A good refresher on the conditions that indicate a Level 2 evaluation can be found here. Please ensure a thorough review of the application and supporting documentation when making admission decisions. An additional tool that will aid in decision-making is a review of the information in CyberAccess. CyberAccess offers many services to providers, such as where Medicaid clients have been receiving services, billed diagnosis and much more. To register for CyberAccess, please contact 888-581-9797.
A new online application link will be provided on COMRU webpage (https://health.mo.gov/seniors/nursinghomes/pasrr.php) starting July 1, 2025.
2025 SLCR Annual Provider Meetings
Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation
Please stay tuned to our weekly LTC Information Update email for more details including online registration, agendas, and CEU information.
September 9, 2025: Region 4
Location: Stoney Creek Hotel, St. Joseph
September 10, 2025: Region 3
Location: Adams Pointe Conference Center, Blue Springs
September 16, 2025: Region 5
Location: Moberly Municipal Auditorium, Moberly
September 17, 2025: Region 6
Location: DoubleTree Hotel, Jefferson City
September 23, 2025: Region 2
Location: Drury Plaza Hotel & Convention Center, Cape Girardeau
September 24, 2025: Region 7
Location: Crowne Plaza St. Louis Airport, Bridgeton
October 8, 2025: Region 1
Location: Oasis Hotel & Convention Center, Springfield
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.
Transfer or Discharge Notice Expectations
Please see the attached Letter to Administrators and Transfer Discharge Tip Sheet-Certified 4.28.25 from the Long-Term Care Ombudsman’s office to clarify newly issued guidance, provided via CMS QSO-25-14-NH, regarding expectations of permitting residents to return to the Nursing Home, referenced herein as the “facility,” following transfer to an acute care setting. This correspondence clarifies the requirements for when the facility transfers or discharges a resident under any circumstances and documentation required for transfers or discharges, and the email address to where a facility is to send copies of discharge notices to the Long-Term Care Ombudsman Program. To support this information, enclosed are a Question and Answer guide and a document that lists county-specific contact information for the Long-Term Care Ombudsman Program.
Official Version of Appendix PP Now Available
The official version of Appendix PP is now posted. Please see the links below for the more information.
https://www.hhs.gov/guidance/document/revisions-state-operations-manual-som-appendix-pp-1
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.
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 of “Mobilize 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!
New QIPMO Newsletter – May 2025
The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 12, Issue 3).
In this issue:
- Honoring the Journey: Upholding Compassion and Quality Through F684 and F849
- Disasters Don’t Wait for Day Shift
- ICAR Corner: TB or Not TB… That is the Question
- New Resident Admissions
- Hip, Hip, Hooray! Moving Forward!
Supplemental Health Care Service “Staffing” Agencies Regulation
Any registered supplemental health care services agency that contracts with a health care facility participating in Medicare or Medicaid is required to submit quarterly reports to the department that contain the following information:
- A detailed list of each health care facility participating in Medicare or Medicaid with whom the agency has contracted over the prior quarter;
- A detailed list of the average “hourly” amount charged by the agency to the health care facility over the prior quarter, broken down by health care facility and each individual health care personnel category within each job classification (including but not limited to nursing, therapy, dietary/nutrition, lab, and radiology); and
- A detailed list of the average “hourly” amount paid by the agency to health care personnel over the prior quarter, broken down by health care facility and each individual health care personnel category within each job classification, including but not limited to nursing, therapy, dietary/nutrition, lab, and radiology.
Pursuant to section 198.644, RSMo, the department is required to prepare an annual report of aggregate data received from the agencies without including information specific to any one agency. This report summarizes data received by the department in 2024, which was the first full year the department received reports.
The 2024 report can be found here: https://health.mo.gov/safety/shcsa/annual-report.html.