CMS released a PDF file labeled “MDS 3.0RAIManualv1.17.1R.Errata.October.1.2021,” available in the Downloads section of the MDS 3.0 RAI Manual webpage. This file contains revisions to pages in Chapter 6 of the MDS 3.0 RAI Manual v1.17.1R that update the NTA Comorbidity Score Calculation table. Changed manual pages are marked with the footer “October 2019 (R).” The errata document begins with a table that lists all identified revisions and the pages to which they have been applied. Following the table are the actual corrected replacement pages for insertion into the printed manual.
Category: Long Term Care Blog
CMS Memo QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements
Long-Term Care (LTC) Facility COVID-19 Testing Requirements (QSO 20-38-NH, revised 9/10/2021)
Please read the memo carefully. CMS has revised testing requirements for nursing homes including testing of symptomatic residents and staff, and routine testing of staff. Two major changes are:
- Facilities now have two options to conduct outbreak testing, through either a contact tracing or broad-based testing approach. See Table 1.
- Routine staff testing is now based on the facility’s county level of community transmission instead of county test positivity rate. The link to determine county level of community transmission is in the memo. The frequency of testing has also been updated. See Table 2.
Table 1: Testing Summary
|
Testing Trigger |
Staff |
Residents |
|
Symptomatic individual identified |
Staff, vaccinated and unvaccinated, with signs or symptoms must be tested. |
Residents, vaccinated and unvaccinated, with signs or symptoms must be tested. |
|
Newly identified COVID- 19 positive staff or resident in a facility that can identify close contacts |
Test all staff, vaccinated and unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual. |
Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual. |
|
Newly identified COVID- 19 positive staff or resident in a facility that is unable to identify close contacts |
Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility). |
Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility). |
|
Routine testing |
According to Table 2 below |
Not generally recommended |
Table 2: Routine Testing Intervals by County COVID-19 Level of Community Transmission
|
Level of COVID-19 Community Transmission |
Minimum Testing Frequency of Unvaccinated Staff+ |
|
Low (blue) |
Not recommended |
|
Moderate (yellow) |
Once a week* |
|
Substantial (orange) |
Twice a week* |
|
High (red) |
Twice a week* |
+Vaccinated staff do not need to be routinely tested.
Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19-0.
New Enrichment Booklet for Residents
National Consumer Voice for Quality Long-Term Care has a NEW Enrichment Booklet offers residents a variety of activities to keep them entertained and active. This book includes puzzles, word searches and crosswords; prompts for residents to write about the connections in their lives; trivia questions, which can be done alone or with others; and more!
Download and print the Enrichment Booklet for free or purchase hard copies of the booklet from the online store.
MHCA Virtual Convention 2021
October 1-31, 2021: MHCA Virtual Convention
For those who attended the convention in-person but missed an education session, you now have access to any missed sessions as well. Therefore, all of the facilities that registered for the in-person Convention are automatically enrolled in the Virtual Convention! Please note – each facility registered for the Virtual Convention can allow an unlimited number of attendees from your registered facility to participate in the education sessions offered virtually.
If you could not attend the in-person Convention, you can register now for the Virtual Convention. Once the Virtual Convention begins, the education sessions will be available 24/7 and run through October 31.
Pioneer Network Hot Topics – Culture Change in Action
October 21, 2021: Someone Just for Me: Recognizing a Critical Role for Volunteers
Speaker: Dr. Paul Falkowski, Ph.D., Gerontologist, Author, Speaker, Educator
Long before COVID-19, professionals working in long-term care knew about the devastating effects of social isolation. Now because of COVID-19, social isolation has become an all too familiar term to the general population. We heard reports of people passing due to being disconnected from their families and friends during the past year. But what about the people who did not have family or friends?
Creating and sustaining intimate relationships takes time and commitment. In this session, you will learn the critical components for creating “authentic” relationships. You will learn how to recruit, screen for, and train a cadre of volunteers, who go on to become “companions” or, as one older woman observed, “…someone that is here just for me.” We’ll look at the transformational power volunteers like these can have on the people you serve, the people serving them, the volunteers themselves, and your surrounding community.
Action Pact’s Conversations with Carmen
October 15, 2021: Why Employees Leave and Ideas for Honoring, Retaining and Recruiting Them
Guest: Linda Shell, RN, PhD; with Host Carmen Bowman
LTC communities face daunting challenges when it comes to the difficulties of staffing right now. Employees have increased expectations of their leaders and managers than in the past. For organizations to thrive during rapid change, they need a mindset shift from traditional problem solving to an increased emphasis on the needs of the employee and the vital roles they hold. Learn to identify the top reasons why employees leave, and ideas for a culture that honors and includes employees like never before.
Action Pact’s Conversations with Carmen
November 19, 2021: Creating Connectedness
Presenter and Host: Carmen Bowman
LTC communities face daunting challenges when it comes to the difficulties of staffing right now. Employees have increased expectations of their leaders and managers than in the past. For organizations to thrive during rapid change, they need a mindset shift from traditional problem solving to an increased emphasis on the needs of the employee and the vital roles they hold. Learn to identify the top reasons why employees leave, and ideas for a culture that honors and includes employees like never before.
Community Education Webinar from VOYCE
November 9, 2021: Protect Your Hard Earned Assets – How to Stay Financially Secure
Presenter: Lauree Peterson-Sakai, SVP, Aging Risk Strategy Leader, Wells Fargo
Join VOYCE for this Community Education webinar. Remember the adage “Knowledge is Power”? That certainly applies to becoming well-informed on all that is involved with aging! Join Wells Fargo’s Aging Client Service Strategy Leader for an informative course on financial safety. Spend the hour breaking down what you need to know about identifying financial exploitation and providing easy tips on keeping you and your money safe throughout your golden years. Registration for this webinar is free.
For any enquiries, please contact jmcgeechan@voycestl.org.
10-Digit Mandatory Dialing Changes
10-Digit Mandatory Dialing Changes Will Impact Fire Alarm Panel Automatic Dialing
The Federal Communications Commission (FCC) has adopted an order approving the designation of “988” as the 3-digit abbreviated dialing code for the National Suicide Prevention Lifeline. As a result of this designation, beginning October 24, 2021, a 10-digit telephone number (area code + phone number) will be required to complete all local calls from area codes 314, 417, 660, and 816. All licensed long-term care facilities in Missouri are required to have a fire alarm panel that dials a monitoring company during a trouble call or fire signal. It is imperative that facility staff verify or reprogram the fire alarm panel to ensure it will dial out with the area code. This will need to be confirmed with the fire alarm and/or monitoring company. For additional information regarding 10-digit mandatory dialing changes, please refer to the FAQs About 10-Digit Dialing document developed by the Missouri Public Service Commission.
Advoque Safeguard Issued Respirator User Notice
On September 17, 2021, Advoque Safeguard issued a user notice identifying 6 very small lots of the model SG100 N95 Particulate Filtering Respirator (TC-84A-9284) that require additional sampling for pressure testing. Any individual or organization in possession of any ASG100 product in the 6 lots should isolate the product and contact Advoque Safeguard Quality Control (qc@advoquesafeguard.com).
More information can be found on the NIOSH Manufacturer Notice webpage: https://www.cdc.gov/niosh/npptl/usernotices/noticesmanufact.html under Advoque Safeguard.
VOYCE Professional & Community Education Series Webinar
October 12, 2021: Cannabis and CBD for Older Adults and LTC Residents
The use of cannabis and CBD products as alternative medical treatments has been widely contested in the United States. Yet, the use of these products can be highly beneficial to patients with a variety of health conditions – many of which are prevalent in aging and long-term care populations. Join us for a discussion with local experts about the function, benefits, and options for medical cannabis and CBD use. This course will also discuss the legal considerations for individuals and long-term care organizations interested in trying these alternative therapies. This webinar is available to both long-term care serving professionals and interested community members.
VOYCE Professional Education Series Webinar
September 28, 2021: Eliminating Elderspeak through Compassionate Communication
Understanding elderspeak as a type of biased communication is vital to prevent future ageist behavior towards older adult patients and, thus, improve health outcomes. Elderspeak, most commonly found in long-term care settings, has been identified as a growing communication barrier between younger and older generations, especially in healthcare. Effective communication between patients and providers improves trust and adherence to treatment plans. Health communication and cultural sensitivity training are crucial for incoming, young health providers. As Boomer clinicians age and retire, they will be replaced by millennials who will need to learn how to navigate intergenerational relationships with their new Boomer patients.
DHSS Health Update
Please see the DHSS Health Update entitled “Update: Indications for Monoclonal Antibodies in Management of COVID-19.”
Should you have any questions, please contact the Missouri Department of Health and Senior Services’ Bureau of Communicable Disease Control and Prevention at 573-751-6113.
Monoclonal Antibody Infusion Medication Information
There has been a significant change in the ordering process for monoclonal antibody infusion medications. If you are currently utilizing these medications, please review the attached notice and plan on attending the webinar tomorrow. Also attached is information on reporting usage through the Teletracking system. Reporting through this system is highly encouraged as the usage reported will determine future amounts allocated to the state.
Status Update re: Monoclonal Antibody (mAb) Infusion Medication Ordering:
Missouri Department of Health and Senior Services (DHSS) was notified by U. S. Department of Health and Human Services (HHS) yesterday, September 14, 2021, that effective immediately the states are responsible to review and approve all monoclonal antibody medication orders. This includes orders for REGEN-COV (casirivimab and imdevimab) and the Eli Lilly cocktail of bamlanivimab/etesevimab through AmeriSource Bergen. This was DHSS’ first notification of this change. We had no prior information to allow for planning, development of platforms for ordering/approvals or procedures, or messaging. Thus, all of this is occurring currently and as quickly as possible. Information on this change is still forthcoming from HHS, thus we may have process implementation delays at the state level as a result.
mAb Request Process Implementation and Timeline:
DHSS will host a webinar to introduce the state’s new mAb request process, details are below:
Friday, September 17, 2021
10:30-11:30 a.m.
|
Join from the meeting link |
|
https://stateofmo.webex.com/stateofmo/j.php?MTID=mcb62b527fff05778bd574584e06c8b6d |
|
Join by meeting number |
|
Meeting number (access code): 2462 582 1044 |
|
Meeting password: pcGjudFE679 |
Tap to join from a mobile device (attendees only)
+1-650-479-3207,,24625821044## Call-in toll number (US/Canada)
+1-312-535-8110,,24625821044## United States Toll (Chicago)
NHSN COVID-19 Vaccination Data Reporting – Additional Dose Questions
Recently, NHSN launched two new questions in the weekly COVID-19 vaccination module. During the reporting week of 8/23/2021 through 8/29/2021, facilities began reporting on the number of individuals eligible to receive additional or booster doses of COVID-19 vaccine (question #4) and the number of individuals who received additional or booster doses (question #5).
Facilities should refer to the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States to determine which individuals are eligible to receive additional or booster doses. According to the current guidance, an additional mRNA COVID-19 vaccine dose is recommended for moderately to severely immunocompromised people after they completed an initial 2-dose mRNA vaccine series. Therefore, facilities should include the following individuals in question #4 as eligible to receive an additional dose of the COVID-19 vaccine:
- Received an initial complete 2-dose mRNA COVID-19 vaccine series at this facility or elsewhere since December 2020 (question 2); AND
- Eligible to receive an additional or booster dose of the COVID-19 vaccine, per CDC guidance noted above.
In response to questions, NHSN received about reporting additional COVID-19 vaccine dose or booster data, scenario examples are provided below to assist in determining how to respond to these new questions.
- Facility A is unsure how to determine who in their facility is considered eligible for an additional dose or booster at this time.
Facilities should refer to the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States to determine individuals who are eligible to receive additional doses or boosters after receiving an initial completed vaccination series. For more information about COVID-19 vaccine indications for individuals who are immunocompromised, please see the FAQs at: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/immunocompromised.html.
- Facility B has a staff member who only received dose 1 of the Moderna COVID-19 vaccine. However, this staff member expressed an interest in receiving an additional dose of the vaccine.
The facility would not include the staff member in questions 4 and 5 on the data collection form since he/she did not complete an initial COVID-19 vaccination series.
- Facility C cannot determine if an individual is eligible for an additional dose at this time because they do not know the individual’s health status to determine if they are immunocompromised.
If a facility is unable to determine whether an individual is considered eligible to receive an additional dose or booster at this time, the individual should not be reported in question 4 or question 5 on the data collection form.
- Facility D is not aware or unable to determine whether any staff members currently meet the eligibility criteria for receiving an additional or booster dose per the Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. However, two staff members have documentation of receiving an additional dose.
For reporting through the NHSN COVID-19 vaccination modules, assume these two staff members were eligible to have received an additional dose of the COVID-19 vaccine. Include these two staff members in question 4 and question 5 of the data collection form.
- After reviewing the current Interim Clinical Considerations for Use of COVID-19 Vaccines, facility E does not have any individuals who are eligible to receive an additional dose or booster of COVID-19 vaccine.
This facility should report that zero individuals are eligible to receive an additional dose or booster of COVID-19 vaccine in question 4. The new question 4 and question 5 on the data collection form are required fields. A value must be entered for each of these questions for the form to be saved successfully. A zero (“0”) should be entered for question #4 and a zero “0” entered for question #5 (select any manufacturer from the dropdown). This will allow the form to save successfully.
Updated resources, including training materials, data collection forms, table of instructions documents, and other supporting materials are available on the following webpages:
Weekly HCP & Resident COVID-19 Vaccination | LTCF | NHSN | CDC
Weekly HCP COVID-19 Vaccination | HPS | NHSN | CDC
Weekly Patient COVID-19 Vaccination | Dialysis | NHSN | CDC
Frequently asked questions (FAQ) have also been updated (please see questions 23-27) and can be accessed using this link: https://www.cdc.gov/nhsn/hps/weekly-covid-vac/faqs.html.
We appreciate your efforts to report these critical data accurately and completely. We encourage updates to previously entered data as needed. If you have any questions or concerns, please let us know. As always, questions can be sent to NHSN@cdc.gov using ‘COVID-19 vaccination’ in the subject line of the message.
COVID Testing Information
State Orders for Abbott BinaxNOW Tests
Missouri is experiencing constrained supplies of the BinaxNOW COVID antigen test cards. Thus, effective September 9, 2021, DHSS is implementing a revised BinaxNOW test ordering cadence in order to conserve supply and assure the optimum availability of BinaxNOW COVID antigen tests for all users. Until further notice, please order no more than two weeks supply of BinaxNOW tests for use by your facility or organization. If our supply allows larger quantities to be ordered, we will modify this process accordingly at that time and notify all users. https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php
To Reinstate Direct Shipments of Abbott BinaxNOW from the Federal government:
Providers should email their facility information, shipping address and the BinaxNOW delivery Point of Contact for the facility and request to be added back onto the direct shipment list to Binax.Team@hhs.gov. Please be aware reinstatement depends upon available supply of tests to the Federal government and this can take several weeks to begin receiving shipments again.
Reimbursement for OUTBREAK Testing
A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.
Transfer and Discharge Procedures – REGULATION UPDATE NOTICE
The Department of Health and Senior Services, Section for Long-Term Care Regulation has drafted emergency and proposed amendments affecting the transfer and discharge hearings referenced in regulation set 19 CSR 30-82.050.
The emergency amendment for 19 CSR 30-82.050 was filed on September 1, 2021, with an effective date of September 16, 2021 and expiration of March 14, 2022. The emergency amendment can currently be viewed at https://www.sos.mo.gov/adrules/EmergenciesforInternet/emergency. The proposed amendment covering this same material will also be published in the same issue of the Missouri Register. The Register publication date is October 1, 2021 for the emergency and proposed amendments and can be found at http://www.sos.mo.gov/adrules/moreg/moreg.asp.
NOTE: The public comment period for the proposed amendments will be from October 1, 2021 – October 31, 2021. The Department will be accepting comments during the comment period by mailing the comments to: Carmen Grover-Slattery, Regulation Unit Manager, Section for Long-Term Care Regulation, Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102-0570 or by emailing to: RegulationUnit@health.mo.gov.
The proposed amendment can be reviewed on our website at: https://health.mo.gov/about/proposedrules/.
LTC Bed Availability Portal Reminder
Reminder: After submitting the initial survey, a confirmation email will be provided for a link to update your survey each day (instead of submitting a new survey). Submitting a new survey results in multiple surveys showing on the map with different bed numbers. This makes it difficult to know which totals are current. Please use the link emailed after the initial submission to edit facility bed availability. Please do not submit an “initial” submission more than once. If information does not change from day to day, the submitter can simply update the date and submit – the prior day’s information will populate.
The survey information will populate an accompanying dashboard that will be available to hospitals to use as a tool in finding placement for those patients who would be best served in a long-term care setting. This dashboard may be accessed at https://mophep.maps.arcgis.com/apps/opsdashboard/index.html#/f1e0745f93fe46b482d8ff4585f821bf. To view instructions on utilizing the dashboard, click on ‘Instructions’ under the map for information.
Action Pact’s Conversations with Carmen
September 17, 2021: Living Life Outside of Groups – Dispelling the Pressure to Hold Them
Most residents end up spending most time in their room, with or without a pandemic. We have needed to hone helping people live life outside of groups all along. Groups can never be 24/7 or meet everyone’s needs anyway. Gift residents with lots of ideas of things to do beyond the norm and beyond television. Encourage people with time on their hands to try something new, do things they have not done in a while, refocus their capabilities, live out passions in adaptive ways and not lose their taste for life no matter their abilities. Work with people to tell their life story, share wisdom, leave a legacy, develop the invention, book or song in their heart, armchair travel, plan, sing, study, sort photos, serve others, and more. What a great moment in time to get creative and go deeper with people. Learn how to have every team member honor and validate every individual’s’ life role/contribution to your community.
DHSS COVID-19 Vaccination Booster Doses Survey
The Department of Health and Senior Services is planning for the upcoming approval of booster COVID-19 vaccination doses and long-term care facilities will be a priority. The federal pharmacy program used to administer first and second doses will not be available, so it is important to ensure long-term care facilities receive the needed support for the administration of booster doses. We are asking for your feedback regarding your facility’s readiness to administer booster doses. https://www.surveymonkey.com/r/VTT296F
For those SNFs (Medicaid/ Medicare certified) that already completed the NHSN survey, we already have your results no further action is needed.
For questions regarding this survey, please contact Lana Hudanick at Lana.hudanick@heatlh.mo.gov or 314-982-8260. Please reply by September 15, 2021.
COVID-19 After Action Report (AAR) Survey – Deadline Extended
The deadline to complete the DHSS COVID-19 After Action Report (AAR) Survey has been extended to Friday, September 3, 2021. Your assistance in helping us gather this important data is greatly appreciated. Please feel free to share the link with your state, regional, and local partners in the following categories:
- Public Health/LPHA
- Hospital
- EMS
- Emergency Management
- Behavioral Health
- Healthcare Coalition Leadership
- State Agency Partners
Please let us know if you have any questions or difficulties with the survey.
John Whitaker – John.Whitaker@health.mo.gov
Brendan Bagby – Brendan.Bagby@health.mo.gov
Changes to Missouri’s Adult Abuse and Neglect Hotline Hours of Operation
The Department of Health and Senior Services (DHSS) is revising the hours of operation for the Missouri Adult Abuse and Neglect Hotline to 7:00 a.m. to 8:00 p.m., 365 days a year, effective September 1, 2021. The Hotline’s former hours of operation were 7:00 a.m. to midnight, 365 days a year. This change will allow the Department to better serve those who need to report concerns of abuse, neglect, and exploitation of vulnerable individuals 60 and older and people with disabilities between 18 and 59.
During fiscal year 2020, DHSS received and investigated 40,714 community and facility reports of abuse, neglect, bullying, and exploitation, involving seniors and adults with disabilities. That amounts to an average of over 111 reports every day. The number of cases continues to rise, but still vastly understates the extent of the problem as experts believe that for every case of adult abuse or neglect reported, as many as 23 cases go unreported.
In November of 2019, DHSS implemented the Adult Abuse and Neglect Hotline online reporting system allowing concerned citizens and mandated reporters to electronically submit reports of abuse, neglect, and exploitation in an efficient, secure, and confidential manner on a web-based platform. The online reporting portal is available 24 hours a day, 7 days per week and provides an alternative to calling the Adult Abuse and Neglect Hotline both during and outside of normal business hours. Since the implementation of online reporting, approximately one-third of all reports are submitted this way. While online reporting has helped to ease the Adult Abuse and Neglect Hotline’s call volume demands, additional efforts are still needed to ensure that no call goes unanswered. The new operational hours for the Hotline will allow for increased staffing during times of highest call volume. This will help reduce wait times for those reporting and make it easier to reach a trained intake professional between 7:00 a.m. and 8:00 p.m. Please note that 9-1-1 should be accessed for emergencies as the Adult Abuse and Neglect Hotline online reporting system is not intended for emergency response.
If you suspect abuse, neglect or financial exploitation of the elderly or an adult with a disability, you may call the Adult Abuse and Neglect Hotline toll-free at (800) 392-0210 or visit www.health.mo.gov/abuse/ to make a report online.
If you have any questions regarding the change in the hours of operation for the Adult Abuse and Neglect Hotline, please reach out to the Department at 573/526-3625 or DSDSOfficeofConstituentServices@health.mo.gov.
Public Health: Better Health. Better Missouri.
CDC Health Advisory/DHSS Health Alert
Please see the CDC Health Advisory entitled, “Rapid Increase in Ivermectin Prescriptions and Reports of Severe Illness Associated with Use of Products Containing Ivermectin to Prevent or Treat COVID-19” and the DHSS Health Alert “Self-medication with Ivermectin for the Treatment and Prevention of COVID-19.”
Should you have any questions, please contact the Missouri Department of Health and Senior Services’ Bureau of Communicable Disease Control and Prevention at 573-751-6113.
Onsite Clinical and On the Job Training for Students Entering Health Care (Nurses, Nurse Aides, Therapy)
SLCR has received questions regarding whether or not Skilled Nursing Facilities can be a clinical or on the job training sight for students entering health care fields. The quick answer is YES! Long-term care facilities can use the guidance from CMS memo QSO 20-39-NH and DHSS visitation guidance as a way to say “YES” to hosting schools who are training our next workforce in long-term care. Students can be considered health care workers who are not employees of the facility but provide direct care to the facility’s residents. They can be permitted to come into the facility as long as they are not subject to a work exclusion due to an exposure to COVID-19 or showing signs or symptoms of COVID-19 after being screened. Facilities should work with the schools to ensure they are aware of infection control policies and procedures and to whom questions can be addressed.
The most recent visitation guidance from CMS and DHSS can be accessed on our website: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php.
For questions related to this, please contact Angela.Duvall@health.mo.gov.
Updated Standing Orders and Affidavits for Third Dose of COVID-19 Vaccine
Following recent announcements from the US Food and Drug Administration and the Centers for Disease Control and Prevention, certain immunocompromised individuals can begin receiving third doses of COVID-19 vaccine in Missouri.
A third dose of the PfizerNBioTech or Moderna vaccines may be administered to moderately to severely immunocompromised people due to a medical condition or combination of immunosuppressive medication or treatments including but not limited to the following:
- Immunocompromised due to solid organ transplant and taking immune suppressing medications
- Immunocompromised due to active treatment for solid tumor and hematologic malignancies
- Immune compromised due to Receipt of CAR-T cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
- Moderate to severe primary immunodeficiency (eg., DiGeorge, Wiskott-Aldrich Syndromes)
- Immunocompromised due to Advanced or untreated HIV infection
- Immunocompromised due to “Active treatment with high-dose corticosteroids or other drugs that may suppress immune response: high dose corticosteroids (ie.,≥ 20 mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blocker or other biologic agents that are immunosuppressive or immunomodulatory”
Individuals who do not meet the criteria for “moderately to severely immunocompromised” do not need a third dose at this time.
In line with federal guidelines, Missouri will use a self-attestation model for people who are moderately to severely immunocompromised. Individuals will not be required to provide documentation of their health status, and they can get third doses at all venues where first and second doses are available.
This guidance does not apply to those who received the Janssen/Johnson & Johnson vaccine. For people who received either Pfizer-BioNTech or Moderna’s COVID-19 vaccine series, a third dose of the same mRNA vaccine should be used. A person should not receive more than three mRNA vaccine doses at this time. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered. Individuals should wait at least 28 days between their second and third doses.
Announcements from federal health officials came after the analysis of studies demonstrating that immunosuppressed people are more likely to get severely ill from COVID-19, are at higher risk for prolonged infection, are more likely to transmit the virus, and experience lower vaccine effectiveness.
Additional information regarding this guidance can be found on the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html.
Interim clinical considerations for use of COVID-19 vaccines can be found at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.
Missouri’s revised standing orders can be found at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/statewide-orders.php.