Discharge Letters

Do Your Facility’s Discharge Letters Have the Right Contact Information for the Appeals Unit?

Failure to provide the appropriate appeal contact information can result in the appeals unit setting aside a discharge. Requests for a discharge hearing are required to be sent to:

Department of Health and Senior Services Appeals Unit
P.O. Box 570
912 Wildwood Drive 3rd floor
Jefferson City, Missouri 65102-0570
Phone: (573) 522-1699
Fax (573) 751-0247
Email: DHSS.Appeals@health.mo.gov

Discharge regulations can be found here: https://s1.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c30-82.pdf.

Quality Reporting Program: Non-Compliance Letters for FY 2023 APU

CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2021, which will affect their FY 2023 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into SNFs’ CASPER folders in QIES on July 13, 2022. 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 11, 2022.

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.

2022 Missouri Tiered Supports Summit

July 16, 2022 & July 27-28, 2022: Nurturing Healthy Communities

Includes presentations from change agents and behavior analysts from across the country.

Family Sessions

Saturday, July 16, 2022: 10:30 – 2:00

Family Sessions are an ideal opportunity for parents, grandparents, caregivers, and the behavioral health professionals who support them to learn more about positive practices and at home implementation of Tiered Supports.

Professional Sessions

July 27-28, 2022: 9:30-12:30

Professional Sessions provide an opportunity for agency administrators, supervisors, agency team members, coaches, DMH team members, family caregivers, and other behavioral health professionals to learn more about positive practices and implementation of Tiered Supports.

FREE CEUs available for RBTs, BCaBAs, and BCBAs – Click to Register

MO Tiered Supports is a state multi-tiered positive behavior support consultation service system. The MMTSS team focuses on teaching and coaching agency teams so they can better serve the individuals in their care. You can click on these underlined links to direct you to more information on Tiered supports: Multi-Tiered Systems of Support and Understanding Missouri Multi-Tiered Supports Webinar

For information on this summit, please visit https://dmh.mo.gov/dev-disabilities/tiered-support-summit/2022.

RAI Process from Start to Finish

August 2-4, 2022: RAI Process from Start to Finish
December 6-8, 2022: RAI Process from Start to Finish

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

Medicare from Start to Finish

September 13-14, 2022: Medicare from Start to Finish
November 8-9, 2022: Medicare from Start to Finish

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

LeadingAge Missouri Annual Meeting & EXPO

September 26-28, 2022: MOMENTUM
Location: The Chase Park Plaza Royal Sonesta, St. Louis

It’s time to reconnect at LeadingAge Missouri Annual Meeting & EXPO at the beautiful Chase Park Plaza Hotel in Saint Louis.

LeadingAge Missouri’s members are eager to connect with you at our Annual Conference & EXPO! This year’s events will offer a wider variety of marketing opportunities sure to suit your goals and budget. The 2022 conference will provide you with a dynamic opportunity to put your life-changing products and services in front of aging services leaders from across Missouri. We are dedicated to helping you to stand out from your competition.

American Rescue Plan Act (ARPA) Funding Opportunity for RCF and ALF

The Department of Health and Senior Services (DHSS) is excited to announce an upcoming reimbursement opportunity available to Residential Care Facilities (RCF) and Assisted Living Facilities (ALF). Through Missouri’s State Fiscal Recovery Funds, operators may seek reimbursement for expenses incurred directly related to preparing, preventing, and responding to the COVID-19 pandemic.

DHSS will begin accepting applications for reimbursement on September 1, 2022. In the coming weeks, additional details about the reimbursement process, reimbursement amounts, eligible expenses, and supporting documentation will be provided. Our goal is to simplify this process for facility administrators as much as possible.

In preparation of the launch of the application, you are urged to take steps now to prepare. If you operate an RCF or ALF and are interested in this funding opportunity, please ensure you are registered as a vendor to receive payment from the State of Missouri. Before operators can complete an application for this opportunity, they must register as a vendor with the state’s financial system – SAM II. If the operating entity is already registered as a vendor with the State of Missouri, you do not need to re-register.

The SAM II registration Vendor Input Form can be found at https://oa.mo.gov/sites/default/files/vendor_input_ach_eftd.pdf. The completed Vendor Input Form must be sent directly to the Office of Administration by fax at 573-526-9813 or by mail to Office of Administration/Accounting, PO Box 809, Jefferson City, MO 65102.

Operator Tips in Registering as a Vendor with the State of Missouri:

  • Be sure to register only the legal operating entity and not all individual facilities owned by the same operating entity.
  • Be sure the address used in the State’s financial system is the same address that will be used as the operator’s address on the application and any accounts payable documentation.

We will keep you updated with more information regarding the RCF/ALF funding opportunity via this listserv.

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

Free Dementia Training – Changing Talk: Online Training (CHATO) to Reduce Behavioral Symptoms in Dementia

CHAT educates staff about reducing elderspeak (infantilizing communication) and results in reduced behavioral symptoms and need for psychotropic medication for residents with dementia. The new online version (Changing Talk: Online Training (CHATO)) consists of 3; one-hour interactive online modules that provide flexible and accessible access for staff.

There is no cost, direct-care staff can earn 3 contact hours, and all staff get a Certificate of Completion for their file.

Benefits to you, your staff, and your residents include:

  • A person-centered approach.
  • Education about elderspeak and better communication strategies.
  • Reduction in resistiveness to care and other behavioral symptoms in residents with dementia.
  • Reduction in the need for psychotropic medication.
  • Convenient, online educational format for busy nursing homes.
  • Qualifies for CMS dementia care training hours requirements.
  • A free, nonpharmacological, evidence-based intervention is an excellent addition to a Quality Improvement Plan.

Here is also a one-page summary of the study.

Please see the website to learn more about CHATO and view our training resources or

Access the Google drive to download the NEW pilot research and CHATO National Trial information.

Interested parties can email Carissa Coleman (below) or complete the interest form on the website.

Carissa K. Coleman, PhD, MA
Research Assistant Professor
University of Kansas School of Nursing
t: 970-270-6839 | ccoleman3@kumc.edu

Prospective Reimbursement Plan for Nursing Facility and HIV Nursing Facility Services Reimbursement Rates Methodology

The MO HealthNet Division (MHD) is modifying the reimbursement plan for nursing facility and HIV nursing facility services to provide for the transformation of MO HealthNet nursing facility reimbursement rates by establishing a new reimbursement methodology, effective for dates of service beginning July 1, 2022. The primary changes from the current reimbursement include updating the cost base for the rates (i.e., rebasing), applying an acuity adjustment or Case Mix Index (CMI) to patient care costs, and providing quality based incentives or Value Based Purchasing (VBP) add-ons to the rate when the facility meets specified quality measures.

The following documents can be found at the MO HealthNet Alerts and Public Notices webpage:

An additional resource, The Missouri Medicaid Nursing Facility Reimbursement Methodology Summary for Fiscal Year 2023, created by MO HealthNet, provides a summary of the changes for the reimbursement plan found in the Prospective Reimbursement Plan for Nursing Facility and HIV Nursing Facility Services document.

Webinar Registration & Recap: Up to Date Vaccination Status: Surveillance Definition Change for COVID-19 Vaccination Modules

Information for NHSN users

The NHSN Vaccination Team hosted a webinar on Thursday, June 23rd to review changes to the definition for individuals considered Up to Date with COVID-19 vaccines for data reporting through the NHSN COVID-19 Vaccination Modules. We learned that some users were unable to join the webinar due to the number of participants exceeding capacity. We apologize for this inconvenience. To address this, NHSN is hosting a second webinar on the same topic (Up to Data Vaccination Status Surveillance Definition Change) on Tuesday June 28th from 12:00-1:00 PM Eastern Time.

Please click the link below to register for the webinar on Tuesday June 28th from 12:00-1:00 PM Eastern:

https://cdc.zoomgov.com/j/1619745620?pwd=ODE3QTNGb1FzNlRvMFB1bHQvd3NGUT09

After registering, you will receive a confirmation e-mail containing information about joining the webinar.

We also wanted to provide answers to a few frequently asked questions that came up during the webinar:

  • The guidance we provided on how to report Up to Date COVID-19 vaccination applies to all facilities that report vaccination data through the NHSN COVID-19 Vaccination Modules including long-term care facilities (LTCF), dialysis facilities, acute care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term acute care hospitals, and ambulatory surgery centers. The information provided regarding case reporting through the Resident Impact and Facility Capacity (RIFC) Pathways applies only to LTCFs.
  • NHSN’s surveillance definition of Up to Date with COVID-19 vaccines is based on CDC’s clinical considerations and Up to Date definition for the first day of the reporting quarter. CDC recently updated the definition of Up to Date vaccination, so the NHSN surveillance definition will change for Quarter 3, 2022, which begins during the reporting week of June 27, 2022 – July 3, 2022.
  • For LTCFs, the NHSN event-level (person-level) vaccination form will classify individuals as up to date and will apply this new definition beginning 6/27. In order for this to happen, you will need to enter date of birth beginning 6/27 for all individuals in the facility since age is now taken into consideration for determining up to date vaccination status. The Excel Data Tracking Worksheets have been discontinued for LTCFs and removed from the NHSN website since the event-level (person-level) vaccination tool is now available for LTCFs.
  • For all other non-LTC facility types (e.g., dialysis, acute care, ambulatory surgery, etc.), the Excel Data Tracking Worksheet is being updated to incorporate the new definition of up to date vaccination. It should be available in the coming weeks. This Excel tool will be maintained until the NHSN event-level vaccination forms are available for non-LTC facilities.

Community Education from VOYCE

July 12, 2022: A focus on Aging Ahead and St. Louis Area Agency on Aging
Presenters: Jan Keith, Director of Community Engagement, Aging Ahead and Jamie Saunders, Information & Assistance Coordinator, St. Louis Area Agency on Aging

Join VOYCE for this Community Education webinar presentation to learn about the valuable services for seniors offered by Aging Ahead and St. Louis Area Agency on Aging. We’ll learn about important services offered throughout the Greater St. Louis region including Senior Housing, Legal Services, Meals on Wheels, Health Insurance Marketplace, Long-Term Care assistance, and Medicare and Medicaid support.

2022 Annual SLCR Provider Meeting

August 24, 2022: Region 6
Location: Capitol Plaza Hotel & Convention Center, Jefferson City

September 1, 2022: Region 5
Location: Quality Inn & Suites, Hannibal

September 7, 2022: Region 4
Location: Stoney Creek Hotel & Conference Center, St. Joseph

September 8, 2022: Region 3
Location: Adams Pointe Conference Center, Blue Springs

September 15, 2022: Region 2
Location: Drury Plaza Hotel Cape Girardeau Conference Center, Cape Girardeau

October 5, 2022: Region 1
Location: Oasis Hotel and Convention Center, Springfield

October 12, 2022: Region 7
Location: Crowne Plaza St. Louis Airport, Bridgeton

The 2022 Updated Provider Meeting Agenda is now available. Please see the flyer for location details.

 

2022 Handouts
1. COMRU Online Application
2. CNA Testing and Renewal Process
3. LTC Regulatory Interpretive Guidance Update
4. Missouri Medicaid Case Mix
5. Section Update
6. Mental Health First Aid – Oct 12 2022
7. Mental Health Care & Crisis Planning For Nursing Facilities
8. ARPA Funding
THE ARTIFACTS OF CULTURE CHANGE 2.0

2022 Enhanced Leadership Development Academy for LTC Leaders

Do you…..

❍ need a leadership course that addresses the unique challenges SNF leaders face?
❍ want to feel inspired and passionate about leading your SNF?
❍ want to connect with other SNF leaders and have access to free professional development, tools, and resources?
❍ want free CE credit without sacrificing quality and practical application?
❍ want to have the flexibility to learn at the pace and place the works best for you?

If you answer YES to any of these questions, this course may be for YOU!

For more information visit our web site, download the postcard or contact Todd Winterbower at winterbowert@missouri.edu.

Take the survey now to see if you qualify for FREE registration.

CMS Memo: QSO-22-17-ALL: Surveys for Compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements

  • CMS is committed to taking critical steps to protect vulnerable individuals to ensure America’s health care facilities are prepared to respond to the Coronavirus Disease2019 (COVID-19) Public Health Emergency (PHE).
  • Survey oversight of the staff vaccination requirement for Medicare and Medicaid-certified providers and suppliers will continue to be performed during initial and recertification surveys, but will now only be performed in response to complaints alleging non-compliance with this requirement, not all surveys. Under prior guidance, all surveys included oversight of the staff vaccination requirement.
  • CMS will revise QSO 22-11 to ensure deficiency determinations reflect good faith efforts implemented by providers and suppliers and incorporate harm or potential harm to patients and residents resulting from any non-compliance.

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/surveys-compliance-omnibus-covid-19-health-care-staff-vaccination-requirements.

MHCA Webinar – Developing New Leaders in Your Facility

Full series recordings are available through September 1, 2022: Developing New Leaders in Your Facility

Ensuring that potential or new supervisors have the skills to lead is vital to the achievement of your clinical, financial, regulatory, and resident experience goals. Far too often staff are promoted simply because they were exceptional in their current roles. A great nurse, cook, or admission coordinator may not yet be ready to be a great unit manager, food service or marketing director. This series will help your people make that leap – and familiarize you with the strategies you need to help them succeed!

MU Care of the Older Adult

August 19-20, 2022: Care of the Older Adult
Location: Holiday Inn Executive Center, Columbia & Virtual

This conference will provide health professionals the opportunity to gain knowledge in interdisciplinary approaches to clinical management and ethical treatment of older adults, a forum to discuss complex care issues common to all who care for the older adult and an awareness of innovative models of geriatric care delivery. The focus is on promoting excellence in gerontology health care by keeping abreast of the latest evidence-based practice.

This conference will be a hybrid event, you may attend in-person or online/virtual. If you choose to attend virtually, information will be emailed to you prior to the conference, using the email address you provide during registration.

New Release: Heat and Humidity can be a Dangerous Combination

(JEFFERSON CITY, MO) – The Missouri Department of Health and Senior Services (DHSS) urges Missourians of all ages to take precautions as heat and humidity rise to dangerous levels.

Heat-related illnesses often affect the very young, the elderly and the chronically ill, but summer temperatures can also take a toll on healthy young and middle-aged adults.

In 2021, 18 people died from heat exposure in Missouri, ranging in age from 35-105 years. Half of the deaths occurred among those between the ages of 35-64.

During prolonged periods of high temperatures, using air conditioning – either at home or by seeking shelter in a local cooling center – is the best preventive measure.

“Heat and humidity can place a lot of stress on the body,” said DHSS Acting Director Paula Nickelson. “Heat exhaustion can come on suddenly, with little warning, and lead to heatstroke which becomes a very dangerous situation.”

During excessive heat, Nickelson urges Missourians to check on friends and neighbors, especially those who are elderly and chronically ill. To report a senior citizen or an adult with disabilities who is in need of assistance due to the heat, call the state’s toll-free abuse and neglect hotline at 1-800-392-0210, or make a report online.

Medications can impair a body’s response to heat, making them more vulnerable to the heat.

There are a number of steps individuals can take to stay cool including:

  • Wear appropriate clothing – wear lightweight, light-colored, loose-fitting clothing.
  • Stay cool indoors – stay in air-conditioned places as much as possible. Find a local cooling center.
  • Stay hydrated – drink plenty of fluids regardless of your activity level, and do not wait to until you are thirsty. Avoid sugary and alcoholic beverages; these actually cause you to lose body fluids.
  • Schedule outdoor activities carefully – try to plan outdoor activity for morning or evening hours when the temperature is coolest.
  • Pace yourself – reduce exercise or physical activity during the hottest part of the day, and take frequent breaks in the shade or in an air-conditioned place.
  • Wear sunscreen – sunburn affects your body’s ability to cool down and can make you dehydrated.
  • Prepare your home – change air conditioner filters, cover windows that receive morning or afternoon sun with drapes or shades, and make sure you have portable fans if necessary.

Knowing the signs and symptoms of heat related illness and how treat them is also important. Signs of heat exhaustion may include muscle cramps; heavy sweating; cold, pale and clammy skin; dizziness; headache; nausea or vomiting; and fainting or passing out. If you think you or a loved one are experiencing heat exhaustion, you should stop physical activity move to a cool place – preferably air-conditioned, loosen clothing, and sip cool water. Seek medical attention immediately if you are throwing up, your symptoms get worse or symptoms last longer than one hour.

Signs of heat stroke may include high body temperature (103°F or higher); hot, red, dry or damp skin; fast, strong pulse; headache; dizziness; nausea; confusion; or loss of consciousness. If you think you or a loved one are experiencing heat stroke you should call 911 immediately. Heat stroke is a medical emergency. Move the person to a cool place – preferably air-conditioned. Help lower the person’s body temperature with cool cloths or a cool bath until medical personnel arrive. Do not give the person anything to drink.

For more information regarding heat-related illness and prevention, visit the websites of DHSS or the CDC.

 

Emergency Protocol for Facilities
The Emergency Protocol was developed in 2007 for communication between long-term care homes and the Section for Long-Term Care Regulation (SLCR), in the event a disaster occurs that results in a loss of a necessary service (electricity, water, gas, telephone, etc.). This protocol was established to streamline communication so that homes can focus on what is most important – the safety and well-being of the residents.

This protocol (Emergency Protocol Handout for Facilities) provides the cellular telephone number corresponding to the region in which your home is located if you experience a loss in a necessary service – for instance Air Conditioning – that has the potential to affect resident safety or well-being. You are encouraged to contact the regional office main office telephone number during normal business hours as survey staff carry the cell phone and may be conducting a survey or inspection during working hours and may not answer immediately.

Provider Feedback Survey

The Section for Long-Term Care Regulation is again seeking input from providers we serve. We are asking for your help in identifying areas in our Section where excellent customer service is provided and areas where we need to focus on improving our customer service experience. Please take a couple minutes to complete our 2022 Provider Feedback Survey by June 30, 2022 at https://www.surveymonkey.com/r/72PRNZY.

June 15 is World Elder Abuse Awareness Day

World Elder Abuse Awareness Day (WEAAD) was launched in 2006 by the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations, in an effort to unite communities around the world to raise awareness about elder abuse.

Each year, an estimated 5 million older adults are abused, neglected, bullied or exploited. World Elder Abuse Awareness Day on June 15 serves as a call-to-action for individuals, organizations and communities to raise awareness about abuse, neglect and exploitation of elders. In Missouri, the Department of Health and Senior Services (DHSS) receives and investigates reports of abuse, neglect, bullying and exploitation of the elderly and disabled. Last year, DHSS received and investigated 42,422 reports, an average of about 116 each day. That number is on the rise, though the crimes are vastly underreported.

DHSS is excited to host a WEAAD Facebook Live event on Tuesday, June 14 at 11 a.m. to help build strong supports for elders in Missouri. Join the discussion and learn how to recognize the signs of adult abuse and how to report it. Everyone is encouraged to wear purple and communities across Missouri are encouraged to display purple ribbons, flags, pinwheels or light up landmarks on June 15 to bring awareness to this public health issue.

Anyone who suspects a senior or disabled Missourian is being abused, neglected, bullied or exploited, should call the toll-free Missouri Adult Abuse and Neglect Hotline at 1-800-392-0210 or report online at health.mo.gov/abuse. The hotline is operational from 7:00 am through 8:00 pm, 365 days a year. Online reporting is available 24/7.

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. To learn more about WEAAD, Adult Abuse in MO, and what you can do to help or to access the WEAAD promotional toolkit, visit: www.health.mo.gov/weaad.

Resident Advocate Newsletter Spring 2022

The Spring 2022 issue of The Resident Advocate is now available. This newsletter provides information on residents’ rights and care issues; news and updates on national policy; and self-advocacy tips for obtaining person-centered, quality care.

This issue includes:

  • An overview of recently released nursing home reforms and how to advocate for better care,
  • Tips for residents as they prepare to vote in elections later this year,
  • Voices of residents speaking about nursing home staffing, and
  • Information about this year’s Residents’ Rights Month.

The Resident Advocate is a great resource to share with long-term care residents. Nursing home staff, long-term care Ombudsman programs, family members, and other advocates are encouraged to forward this newsletter to residents or print and share copies. Download this issue or past issues from our website.

MHCA Annual Convention

August 28-31, 2022: MHCA 74th Annual Convention & Trade Show
Location: Branson Convention Center, Branson

The Missouri Health Care Association invites you to join us at the 74th Annual Convention & Trade Show! MHCA is excited to bring you another year of the most requested and up-to-date education sessions available. Each day is scheduled to offer a wide range of education to meet the needs of the entire staff. Convention will be held again this year at the Branson Convention Center, conveniently located adjacent to the Branson Landing which is enjoyed by many. Don’t miss the opportunity to tour the Trade Show, widely regarded as the leading long term care trade show in Missouri with over 150 booths.

Show-Me ECHO Invites Participants

The Show-Me ECHO (Extension for Community Healthcare Outcomes) invites you to join the Post-Acute and Long-Term Care ECHO (PAC/LTC). Sponsored by the Missouri Telehealth Network at the University of Missouri, the PAC/LTC ECHO supports providers and administrators who work at or with residential care communities. The ECHO meets virtually on the 2nd and 4th Thursday of each month from 9:30 – 10:30 am (central time). To learn more about the PAC/LTC ECHO, please see flyer or visit www.showmeecho.org.

Virtual CST Certification Training & Summer Geriatric Institute

June 15, 2022: Cognitive Stimulation Therapy Certification Training
June 16-17, 2022: Caring for Older Adults and Families

The Saint Louis University Summer Geriatric Institute is an annual continuing education event for practitioners, faculty, fellows, residents, and students who are or will provide care and services to older adults and their families. The Institute includes lectures and workshops by an interprofessional group of practitioners and researchers on new and emerging areas of geriatric medicine and services. As an extension of the Institute, a one-day training on Cognitive Stimulation Therapy (CST) will be offered. CST is a non-pharmacologic intervention for persons with mild to moderate dementia. The training fulfills the first requirement for CST Facilitator Certification.

The audience for this program includes students and professionals working with older adults, with a special emphasis on clinicians and administrators, including physicians, nurses, occupational therapists, social workers, physical therapists, speech therapists, dietitians, marriage and family therapists, nursing home administrators, and those who specialize in alternative medicine.