COMRU Online Application

We are aware that some providers are experiencing issues with the link to the COMRU online application. We apologize for this inconvenience. Please first try the following alternative link to see if this will work to access the online application:

If this link does not work, please contact COMRU at for assistance. 

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 (Revised 9-23-22)

CMS has issued updated visitation guidance to reflect the new CDC guidance related to routine testing of staff. Routine screening testing of asymptomatic staff is no longer recommended but may be performed at the discretion of the facility.

Testing is not necessary for asymptomatic people who have recovered from COVID-19 infection in the prior 30 days. Testing should be considered for those who have recovered in the prior 31-90 days.

Please review the memo in its entirety at

CMS Memo: QSO-20-39-NH: Nursing Home Visitation – COVID-19 (Revised 9-23-22)

CMS has issued updated visitation guidance to reflect the new CDC guidance, released September 23, related to face coverings and masks. The safest practice is for residents and visitors to wear facing coverings or masks, however, the facility could choose not to require visitors to wear face coverings or masks while in the facility if the nursing home’s county COVID-19 community transmission is not high, except during an outbreak.

Please review the memo in its entirety at

Resolution of Issues: NHSN Person-Level (Event-Level) COVID-19 Vaccination Forms

We want to provide an update on the issues related to the Person-Level (Event-Level) COVID-19 Vaccination Forms that occurred following the recent NHSN application update. These issues are now resolved, and users can do all of the following:

  • Users can search and filter their data
  • Users can import .CSV files that contain more than one row per individual (for example, if an individual was discharged and later re-admitted)
  • Users can modify all fields, including ID and name
  • Users can no longer delete staff IDs from the other event-level forms (e.g., from the POC tool) if the staff ID is linked to a staff vaccination record

As a reminder, users cannot delete rows. If you have incorrect data that needs to be removed, please do one of the following:

  1. Edit the row/ repurpose the row with someone else’s data, or
  2. Change the discharge/end date to a date that is before the person-level forms could be used to submit date (i.e., before 3/28/2022). This way, the incorrect row won’t contribute to any data that can be submitted. In addition, you should change the ID so that it is not linked to a real ID. Also, add a note to the Comments column on the far right to document that this entry is incorrect.

In addition, updated CSV materials for the Person-Level (Event-Level) COVID-19 Vaccination Forms are now posted to the website, and links are provided below. Please note that is it optional to use the CSV materials, as users can manage all data within the application without using the CSV files.


All resources:



.CSV variable description and file layout:

.CSV template and example – HCP:

.CSV template and example – Residents:

Please contact with “COVID-19 Person-level Vaccination Forms” in the subject line with any additional questions or concerns. Thank you for your efforts with submitting data to the Weekly COVID-19 Vaccination Modules.

NHSN Long-term Care Release September 2022

Below is important information regarding modifications to the Long-term Care Facility COVID-19 Module, and COVID-19 Vaccination Module. The changes described below will take effect after the September 2022 NHSN release. Resources on the NHSN LTCF COVID-19 Module webpage and the COVID-19 Vaccination Module webpage will be updated, where indicated, with revised forms, instructions, FAQs, and .CSV templates.

Point of Care (POC) Test Reporting Tool:

No enhancements

COVID-19 Pathway Data Reporting:

Please refer to the below data reporting pathways to learn about enhancements that will be made within each pathway.

Resident Impact and Facility Capacity Pathway:

The Primary Series Vaccination Status section of the Resident Impact and Facility Capacity Pathway has been revised with simplified language to account for the recent approval of the Novavax Vaccine. The reporting process for this pathway has not changed and users will not need to go back and make any revisions to their data. Please continue using the Table of Instructions, found on the LTCF COVID-19 Webpage, as a guide while reporting data for this pathway.

Staff and Personnel Impact Pathway:

No enhancements

Therapeutics Pathway:

For those that upload data via CSV files, please be sure to use the templates that are posted on the LTCF COVID-19 Module Webpage. The following therapeutics must be listed for each submission date within the CSV file.

Each Therapeutic should have a line within the CSV file:

  • Casirivimab plus Imdevimab (Regeneron)
  • Bamlanivimab plus etesevimab (Lilly)
  • Sotrovimab (GlaxoSmithKline)
  • Evusheld (AstraZeneca)
  • Bebtelovimab (Lilly)
  • Paxlovid (Pfizer)
  • Molnupiravir (Merck)

State Veterans Homes COVID-19 Event Reporting Tool

No enhancements

Weekly NHSN COVID-19 Vaccination Data

Optional NHSN Person-Level (Event-Level) Vaccination Forms

  • Enhanced security for Staff-Person-level (event-level) vaccination data.
  • Action item for users: If a user is not a NHSN facility administrator (FA) and submits person-level vaccination data for healthcare personnel, the user must have the ‘Staff/Visitor- Add, Edit, Delete’ and ‘Staff/Visitor- view’ boxes checked under user rights. A user with administrative rights can grant these additional rights to users. Facility administrators will continue to have access to these person-level vaccination data.

For questions about any of these updates, please send an e-mail to the NHSN Helpdesk at with the subject line identifying the topic of the message.

COMRU Update

Beginning October 3, 2022, the Level 2 determination letters will be sent from Bock Associates instead of COMRU. The Level 2 determination letter will continue to be uploaded to the online application. If you have any questions regarding the change in the determination letter, please contact COMRU at 573-522-3092 (option #4).

Please ensure the processed online application and Level 2 screening has been printed/saved for your records. COMRU will begin purging the online system in October, so all Skilled Nursing Facilities (SNF) will need to have copies of these documents prior to them being deleted.

The Green House Team FREE Fall Webinars

September 27, 2022: Person-Directed Leadership: Creating a Coaching Culture
October 4, 2022: Invest in Your Workforce for 2023
October 11, 2022: Communicating for Policy Success

Join Amanda Loomis of SWBR for a dynamic exploration of the ways that design can promote vitality and wellbeing for elders – and how small touches can go a long way toward revitalizing a nursing home, assisted living community, or other eldercare setting.

2022 MOADD Summit

November 9, 2022: Missouri Alliance for the Dually Diagnosed (MOADD) Summit
Location: Holiday Inn Executive Center, Columbia

MOADD (Missouri Alliance for Dual Diagnosis) established in 2018, is a collaborative effort between Department of Mental Health (DMH) staff and DMH providers with interest in developing expertise in supporting individuals with dual intellectual/developmental disabilities (I/DD) and behavioral health diagnosis.

MOADD provides resources to assist providers to:

  • Be current in best practices
  • Develop an integrated system to make agencies more aware of resources for behavioral health and DD available through Regional Professional Learning Communities.
  • Provider better outcomes for individuals

MALA’s 2022 ALF Community Based Assessment Training

November 29-December 1, 2022: 2022 ALF Community Based Assessment Training

As required by 198.005 RSMo and 19 CSR 30‐86.047, residents of Assisted Living Facilities are required to undergo a community-based assessment performed by an appropriately trained and qualified individual. This individual must complete a DHSS approved 24‐ hour training program prior to performing resident assessments. The MALA ALF Assessment Training satisfies this regulatory requirement.

LTC Survey: Staff Emotional Trauma and Need for Peer Support

The Center for Patient Safety is working with Dr. Sue Scott from MU Healthcare/University of Missouri to learn more about the experiences of LTC staff (at all levels) that might involve emotional trauma and the need for peer support. Experts from the MU Sullivan School of Nursing have also contributed to its development.

The online Long-Term Care Survey 2022 should take about 5 minutes. All responses are anonymous; Dr. Scott will aggregate them as a single group.

The Center for Patient Safety looks forward to input from the LTC community as they develop peer support/second victim programs.

Please contact the Center for Patient Safety for questions:

Kathy Wire, Executive Director
(573) 636-1014, ext. 1224

Eunice Halverson, Patient Safety Specialist
(573) 636-1014, ext. 1226

iQIES Provider Security Officials Onboarding for MDS

CMS announced they are preparing to release the Internet Quality Improvement Evaluation System (iQIES) for Minimum Data Set (MDS) submission in early 2023. Although the MDS submission functionality will not be available immediately, CMS encourages 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. At a minimum, at least one PSO needs to be selected, but CMS highly recommends that at least two PSOs are designated so that there is a higher likelihood that there will be someone available to approve/reject iQIES access requests. Nursing homes and Swing Beds in CMS Region 7 (which includes Missouri) should onboard their Provider Security Officials October 31, 2022 through November 11, 2022. The onboarding of other nursing home and swing bed hospital staff can begin on November 15.

Onboarding Schedule for MDS Transition to iQIES:

iQIES Onboarding Process Quick Reference Guide for the Provider Security Official Role:

COVID-19 Study – University of Missouri Sinclair School of Nursing

Drs. Amy Vogelsmeier and Lori Popejoy from the University of Missouri Sinclair School of Nursing are conducting a statewide study to understand how nursing homes prepared for and responded to COVID-19 so that they can describe how COVID-19 impacted nursing home staff, residents, and families.

We would like to conduct interviews with leadership (the Administrator/Director of Nursing), the infection preventionist, a group of 6 to 8 staff members and two residents and/or family members. Each of these five interviews should last no more than one hour. A member of our study team will come to your nursing home to conduct the interviews; we complete the interviews all in one day. The information provided will be kept confidential and only the research team will have access. As part of participation in the project, we will compensate your nursing home with a $500 payment.

If you are interested in participating, please contact Steve Miller at 314-322-9510 or via email at

HQIN Offers No-Cost Emergency Preparedness Plan Reviews

Unsure if Your Emergency Preparedness Plan Meets Infection Prevention and Control Requirements. HQIN Can Help!

Health Quality Innovators (HQI) serves as the CMS-designated Quality Improvement Organization for Missouri. Facilities throughout the state partner with our Health Quality Innovation Network (HQIN) on various projects to improve operational processes and clinical outcomes.

Based on lessons learned throughout the pandemic, HQIN is offering a no-cost virtual review of participating nursing homes/ emergency preparedness plans with a focus on integration of infection control and prevention. This support is intended to enhance emergency response and survey readiness.

An HQIN representative will contact you to schedule a review or you may request a review by emailing

News Release: $10 million in ARPA funding for Missouri RCFs and ALFs

Missouri residential care and assisted living facilities licensed with the Missouri Department of Health and Senior Services (DHSS) are now eligible for reimbursement for COVID-19-related expenses through the American Rescue Plan Act (ARPA). $10 million of this federal funding has been allocated for reimbursement.

Providers may seek reimbursement for expenses incurred and/or business interruption costs directly related to preparing, preventing and responding to the COVID-19 pandemic. The funds will compensate expenses incurred between April 1, 2021 and March 31, 2022. Expenses eligible for reimbursement include:

  • Payroll costs.
  • Training and orientation.
  • Operational supplies.

“Missouri’s residential care and assisted living facilities had some of the most challenging situations to navigate throughout the pandemic, from infection control management to workforce and equipment shortages,” said Paula Nickelson, DHSS acting director. “This reimbursement opportunity will allow facilities to recover from the unprecedented challenges the past two and a half years have presented so they can focus on providing care to some of Missouri’s most vulnerable.”

DHSS created two portal guidance documents to assist operators with registering online and navigating the portal. Operators will need to register on the MO ARPA portal before they can apply. An application checklist and FAQs can be found on

A link has also been posted under the Information for Long-Term Care Facilities/COVID webpage at

ALC Memory Care Certification Standards Review Panel

The Joint Commission is developing a new Assisted Living Community (ALC) Memory Care Certification (MCC) program. This program will promote consistent high quality dementia care and assist organizations in providing a safe living environment across the assisted living industry for residents living with dementia.

The MCC program is being developed in collaboration with the Alzheimer’s Association and aligns with their Dementia Care Practice Recommendations. The program will include standards requirements addressing the environment, staff training, emergency management, leadership, medication management, resident care, treatment and services, process improvement, and more.

Note: The survey includes 14 questions about specific standards and 4 focused questions for you to review and provide feedback. Please download and review the ALC Memory Care Requirements document for the full set of standards and provide any additional feedback you may have prior to submitting your survey. This document requires Adobe Reader.

The survey should take about 35 to 40 minutes to complete. Please use the arrows at the bottom of each screen to move forward or backward within the survey. If you are unable to complete this survey in one sitting, the survey tool will automatically save your responses. When you are ready to continue, please click on the link and you will be directed to your remaining questions.

Note: Due to the programming of the Qualtrics software, your data can only be identified from one IP address. Therefore, the survey must be started and completed using the same computer.

Comments will be gathered for six weeks beginning

August 15, 2022 and ending on September 26, 2022.

Thank you in advance for your time and thoughtful responses. If you have any questions, please contact Beth Ann Longo at

New COVID-19 boosters targeting currently circulating strains becoming available in Missouri

Bivalent COVID-19 boosters are becoming available among some providers in Missouri beginning as early as today with additional providers adding these boosters to their inventory next week. A list of providers who pre-ordered these booster doses is available at

On Sept. 1, CDC Director Rochelle P. Walensky, MD, MPH, endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendations for use of updated COVID-19 boosters from Pfizer-BioNTech for people ages 12 years and older and from Moderna for people ages 18 years and older.

The Moderna and Pfizer bivalent boosters both target two strains of SARS-CoV-2, the virus that causes COVID-19 – the original strain of the virus and two of the Omicron subvariants (BA.4 and BA.5), which are currently the most widespread variants globally. Only individuals who have completed their primary vaccination series (two doses of Pfizer or Moderna or one dose of Johnson & Johnson) are eligible to receive the bivalent booster. Those who have recently received Novavax are not yet eligible for any booster at this time.

“We encourage those who are eligible to receive this new booster dose as it will greatly help protect individuals from the variant most commonly detected today and for the past several months,” said State Epidemiologist Dr. George Turabelidze with the Missouri Department of Health and Senior Services (DHSS). “As we head into the fall and winter months, this added protection becomes even more important since viruses generally tend to circulate at a more rapid pace during this time.”

In the coming weeks, CDC also expects to recommend updated COVID-19 boosters for other pediatric groups, per yesterday’s discussion and evaluation of the data by ACIP. When data is available and FDA authorizes these other types of COVID-19 boosters and CDC provides use recommendations, the CDC and DHSS will work to quickly make them available in Missouri with the help of COVID-19 vaccinators throughout the state.

If you have not been vaccinated or have not completed your primary series, visit to find a location offering vaccines. The original formulations of Pfizer, Moderna, J&J and Novovax will continue to be used. Booster doses use reduced amounts of the original vaccines.

Individuals are eligible for the bivalent booster two months since their last primary or booster dose of Pfizer, Moderna or Johnson & Johnson. The previous monovalent booster will no longer be available to persons 12 and older; the FDA is removing authorization for those boosters to reduce provider confusion for staff administering vaccines.

The Pfizer bivalent booster is currently authorized for ages 12 and older while Moderna’s is currently authorized for 18 years of age and older. Individuals may choose to receive either the Pfizer or Moderna bivalent booster, regardless of which primary series vaccine or original booster dose they had previously.

For the latest information on bivalent boosters, visit

Funding Opportunity for Residential Care and Assisted Living Facilities

The Missouri Department of Health and Senior Services (DHSS) is excited to announce a reimbursement opportunity available to Residential Care Facilities (RCF) and Assisted Living Facilities (ALF). Beginning, September 1, 2022, operators may apply for reimbursement for expenses incurred between April 1, 2021 and March 31, 2022, directly related to preparing, preventing, and responding to the COVID-19 pandemic.

If you operated a residential care facility or assisted living facility licensed with DHSS between April 1, 2021 and March 31, 2022, you are eligible for reimbursement for allowable expenses.

Before operators can complete an application for reimbursement:

  1. Operators must be registered as a vendor with the State of Missouri and must have provided their Federal Employer ID Number (FEIN) to DHSS.
  2.    If not already registered, complete the Vendor Input Form located here. Completed forms must be sent to the Office of Administration by fax at 573-526-9813 or by mail to PO Box 809, Jefferson City, MO 65102.
  3. The address used in registering as a vendor must be the same address used on the reimbursement application. Be sure to register only the operating entity and not all individual facilities owned by the same company.
  4. Email registered name and FEIN to

For your convenience, you will find a Frequently Asked Questions and an Application Checklist attached to this communication. These documents can also be found online at under Operators of Residential Care / Assisted Living Facilities.

Funding for this initiative has been made available through the American Rescue Plan Act (ARPA). Missouri’s ARPA funding opportunities are located here:

ARPA Funds FAQ 2022 0829 final
ARPA Funds Checklist 2022 0829 final

Nursing Home Staffing Study Blog and Stakeholder Listening Session

CMS published a blog describing the multi-faceted approach the agency is taking to determine a minimum staffing level for nursing homes in order to ensure safe and quality care.

Also included in the blog is a registration link for an upcoming Stakeholder Listening Session that CMS is conducting for the public, scheduled for Monday, August 29, at 12:00-1:30 pm (central).

Online Course for CNA Instructor Required 4-Hour Update

MANHA and MHCA provided in-seat update training in 6 locations earlier this year. We are now offering the update training online. To access you can go to click on Course Groups. You will find the “CNA Instructor 4 Hour required update” under Train the Trainer course group. Once you complete you will NOT need to do anything else if course is 100% complete. August 30th we will report all RNs who have completed the training to DHSS, Health Education Unit and you will be updated on the registry.

The objectives of this course will meet the elements of the required training to include:

  1. Instruction on how to complete form DHSS-DRL-111 (08-20), Classroom and On-the-Job Training Record;
  2. Instruction on the fundamentals of adult learning;
  3. Instruction in at least one (1) area regarding standards of practice in long term care such as pressure ulcer prevention, dining practices, or resident rights issues;
  4. Instruction on providing care for cognitively impaired residents;
  5. Review of the Nursing Assistant Training Program regulations contained in 19 CSR 30-84.010; and
  6. Review of the administration and resident care requirements contained in 19 CSR 30-85.042.

Any instructor who has not completed the required four (4) hour update training by August 30, 2022, and every five (5) years thereafter shall be removed from the department-approved list of instructors. If removed from the department’s list, the instructor shall attend and successfully complete the Nursing Assistant Instructor Workshop in order to be reinstated to act as an instructor.

Free Resources Can Help Boost Vaccine Confidence

Health Quality Innovation Network (HQIN), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Missouri, recently released three new tools in the fight against COVID-19.

The Why Wait? Vaccines Can Keep Us Healthy video and the Is It Time to Get Your Booster? video are both under two minutes long. They can be shown in reception areas, common spaces and through electronic communications with staff, residents and families.

Additionally, the Direct Exposure Infographic poster displays the differences in COVID-19 illness and death among those unvaccinated, vaccinated and fully vaccinated. It can be shared electronically or printed and displayed in high-traffic areas.

Check out and share these free tools to help spread education, rather than the virus.

New QIPMO Newsletter – August 2022

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 9, Issue 4).

In this issue:

  • Another Gem Added
  • Monkeypox
  • ICAR Corner
  • Coming Soon… New Surveyor Guidance
  • GDR in Psychotropic Medication Management
  • Coaching Skills
  • Value-Based Purchasing Incentive

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

CNA Instructor 4-Hour Update Training Requirement – Due 8/31/22

As of 12/30/21, the new CNA regulations require the CNA instructor to take a four-hour update training every five years. Please see below the regulatory language:

19CSR-84.010 (15)(C)

Any instructor who has not completed the required four (4) hour update training by August 31, 2022, and every five (5) years thereafter shall be removed from the department-approved list of instructors. If removed from the department’s list, the instructor shall attend and successfully complete the Nursing Assistant Instructor Workshop in order to be reinstated to act as an instructor

All current instructors who have not taken the instructor 4 hour update training by August 31, 2022, will be removed as a CNA Instructor from the registry.

*The four hour update training is still required to be completed by August 31, 2022 even if you have recently taken the Train the Trainer course (unless the four hour update training was included) to become a CNA instructor.

If you have any questions, please contact the Health Education Unit at or call us at 573-526-5686.