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.
Category: Long Term Care Blog
Updated Versions of the Final MDS 3.0 Item Sets and Final MDS 3.0 RAI User’s Manual Now Available
On September 23, 2025, CMS posted the final Minimum Data Set (MDS) 3.0 Item Sets version (v)1.20.1v4 which can be found 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 (v4) will go into effect October 1, 2025.
On September 24, 2025, CMS posted an updated final MDS 3.0 RAI User’s Manual version (v)1.20.1 which can be found in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. This final version of the MDS 3.0 RAI User’s Manual v1.20.1 will go into effect October 1, 2025.
DMH Free Webinars – Tools for Everyone
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, including 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.
Registration is available on the DMH Webinars page.
Nursing Facility Level of Care (LOC) Process Changes
In July 2025, the Department of Health and Senior Services Central Office Medical Review Unit (COMRU) and the Department of Mental Health (DMH) made changes to the processing of Pre-Admission Screening and Resident Review (PASRR) Level 1 applications that indicated a Level 2 evaluation should be completed. The goal of these changes was to streamline the process and to decrease the review time for these applications. This goal was accomplished, and applications are currently being reviewed by COMRU and sent to DMH within two working days of receipt.
To further enhance the efficiency of the process, effective October 1, 2025, Bock Associates, the DMH contractor that completes the Level 2 evaluation, will also begin conducting the level of care (LOC) on applications that indicate a Level 2 evaluation is needed. The LOC for these applications is currently conducted by COMRU following the Level 2 evaluation. In addition to further streamlining the process, this change will enhance the quality of the review as most of the Level 2 evaluations are conducted in person. In addition, any issues, questions, or corrections can be addressed immediately without the back-and-forth process that is currently in place. COMRU will work closely with DMH and Bock Associates to ensure a smooth transition.
COMRU will continue to conduct the LOC review for Level 1 applications, applications DMH determines “No Level 2 Required” (NL2R), applications Bock Associates determines did not meet the federal requirement, and Special Admission Category (SAC) applications. The change to the process will also improve the timeliness of these reviews.
This change will have no impact on the application or on the submission process.
Tips and Reminders
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.
Section D – Level One Screening Criteria for Serious Mental Illness
- Question 2 – Depression is often listed under this question, but it should not be included. A diagnosis of depression is different from a diagnosis of major depressive disorder.
- Question 6 – Please review carefully to ensure this question is answered correctly. Incorrect answers will be returned for correction.
Section E – Level One Screening Criteria for Intellectual Disability or Related Condition
- Question 2a – Thoroughly review all diagnoses listed, including those in purple text. In addition, diagnoses of traumatic subdural hemorrhage, traumatic subarachnoid hemorrhage and anoxic brain damage should be listed under head injury/traumatic brain injury (TBI). Please review carefully to ensure this question is answered correctly. Incorrect answers will be returned for correction.
Nursing Facility Level of Care Assessment
The LOC application is used across different settings, including approval for Home and Community based services. The application is an evaluation of the applicant’s current needs. Questions regarding Eating, Meal Preparation and Medication Management should be answered based on the applicant’s ability to complete these tasks, not on what services the nursing home provides. While residents of nursing homes do not normally prepare meals or manage their medications, the appropriate evaluation of these items is required. When answering these questions, it may be helpful to review the assistance needed in other areas, including other ADLs and the applicant’s cognitive status, to determine the most appropriate answer.
Section C – Recent Medical Incidents
- All attachments must be in PDF format.
- The applicant’s name must be listed on all attachments.
- It is not necessary to list diagnoses if a diagnosis list is attached.
- For Level 1 applications, it is not necessary to attach a H&P if the date and reason for hospitalization is explained in the comment section.
- For Level 1 applications, the H&P should be limited to the date/reason for hospitalization. Applications that indicate a Level 2 require additional information.
Section D – Assessed Needs
- Behavioral:
- “Date of last consult…” is a psychiatric consult, if conducted. This should not be completed for a medical visit.
- If behavior symptoms are checked, please review response – this would be either 3 (past) or 6 (current) points.
- Mobility:
- Describe the assistance required, rather than simply listing mode of locomotion. For example, do not just list wheelchair/walker.
- Rehabilitative Services:
- Scoring should be all frequencies added together.
- Safety:
- This question is a two-tiered evaluation. First, a preliminary score is determined based on vision impairment, fall history (within the last 90 days), and problems with balance. After the preliminary score is determined, additional points are given for prior institutionalization (within the last 5 years) and age of 75 years and over. No points are given for the current nursing home admission and the dates for the current admission should not be listed.
For additional information, including training opportunities, visit the COMRU Website.
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.
Nurse Aid Candidate Handbook Update
The Missouri Nurse Aide Candidate Handbook for CNA testing has been updated effective September 2025.
Please see the changes and let us know if you have any questions. You may contact us at CNARegistry@health.mo.gov or call us at 573-526-5686.
Nursing Home Reimbursement: Beginning to End
The Family Support Division (FSD), Department of Health and Senior Services Central Office Medical Review Unit (DHSS COMRU), and the MO HealthNet Division (MHD) have collaborated to create a new resource for nursing facility providers. We are excited to announce, Nursing Home Reimbursement: Beginning to End.
This resource will walk a provider through the process of nursing home reimbursement from the very beginning of an individual applying for coverage, through the Preadmission Screening and Resident Review (PASRR) process, to billing and receiving payment for services. The resource includes step-by-step instructions for each process, definitions, contact information, and more.
For additional training opportunities, check out the below:
- MHD offers an interactive webinar for nursing home providers quarterly. This training covers navigating MO HealthNet provider resources, proper billing methods, procedures for claim filing via eMOMED, and more. This training includes an opportunity to ask questions in real-time. Review the MHD Provider Training Calendar here.
- COMRU PASRR and Level of Care (LOC) Orientation Training, hosted by COMRU, has a monthly orientation training to review the requirements of the PASRR and the Nursing Facility LOC application process.
For additional resources, refer to the Education and Training Resources page and/or sign up for a live webinar by accessing our Provider Training Calendar. For more information, email MHD.Education@dss.mo.gov.
Missouri Master Plan on Aging seeks final input from all Missourians
The Department of Health and Senior Services (DHSS) and Missouri Area Agencies on Aging have published the draft of the Master Plan on Aging: Missourians Aging with Dignity and are seeking comments from the public before the plan is finalized. The comment period is open now through Sept. 15.
A Master Plan on Aging is a cross-sector, state-led strategic resource that can help transform the infrastructure and coordination of services for Missouri’s rapidly aging population. The plan helps build bridges across government agencies, facilitate collaboration with diverse stakeholders, promote equity, raise awareness among policymakers and the public, establish statewide priorities, and incorporate an aging and disability lens across state priorities beyond traditional health care and community.
There are currently more than 1.1 million Missourians over the age of 60. Estimates suggest that older adults will outnumber minors for the first time by 2030 and older adults will greatly outnumber minors by 2060, and the older adult population is also becoming more diverse. These demographic shifts will have a profound impact on the volume and types of services and support that states provide to older adults and people with disabilities, as well as family caregivers. Additionally, approximately 15 percent of the state’s residents have a disability, the most common of which is mobility disabilities. As the population ages, the number of individuals with disabilities is expected to increase.
Aging with Dignity: Missouri’s Master Plan on Aging is a 10-year forward-facing plan that will begin in 2026 and run through 2035. It was established by Governor Parson through executive order in January 2023. The following activities to gain community input have occurred since then:
- An advisory council convened to guide the process of creating the plan. Seven subcommittees comprised of subject matter experts from diverse communities of practice and constituents met regularly to assess the resources and services currently available in the state, find areas of duplication or gaps in service, and determine possible areas for growth.
- A series of town hall meetings throughout the state was held to gather feedback from local individuals who know about challenges in their own communities. These results were analyzed and provided to the advisory council, seven subcommittees and local agencies.
- To gain further insight, the needs assessment was launched in 2024. The effort began with the mailing of over 130,000 postcards to randomly selected residents from all counties of the state. The survey was open to anyone in Missouri who wished to share their needs and wants as the State continued the process of developing the Master Plan on Aging.
“The amount of participation and support we have seen from Missourians across the state over the past two years has been inspiring,” said Mindy Ulstad, who leads the Bureau of Senior Programs within DHSS. “We feel confident that the plan, which is the result of an immense amount of collaboration and active listening, will encompass the needs and wants for all Missourians as we age.”
Community participation has been vital to the process of developing the Master Plan on Aging. Missourians are invited to provide feedback on the draft Master Plan on Aging by submitting comments by emailing MOStatePlanOnAging@health.mo.gov. The draft will be available for public comment until Sept. 15. After public comments, the final plan will be delivered to Governor Kehoe before the end of the calendar year.
The overarching goal of the Master Plan on Aging is that all Missourians, regardless of age or ability, will have access to person-centered programs and services necessary to help them age in their environment of choice in a safe and healthy manner. Learn more about Aging with Dignity.
Temporary Pause of Nursing Home Compare Updates
CMS recently transitioned to a cloud-based Internet Quality Improvement and Evaluation System (iQIES) for nursing home survey and certification data. To ensure accuracy of publicly reported information during this transition, Nursing Home Care Compare updates will be temporarily paused as of July 30, 2025. Updates will resume in October 2025. This temporary pause allows CMS to ensure the accuracy and reliability of publicly reported nursing home quality information. QSSAM-25-03-NH
New QIPMO Newsletter – August 2025
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
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.