Category: Long Term Care Blog

SLCR Life Safety Code Information Series

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The Section for Long-Term Care Regulation will be releasing a series of Life Safety Code Information. You may also view the entire Life Safety Code document for reference.

Today’s subject is:

           What kind of documentation should a facility provide to the surveyor when on a fire watch?

Most facilities have one fire watch policy. If a facility has one policy, then the policy must have all the items in Chapter 15 within NFPA 25, 2011 edition. If the facility has two separate policies, the sprinkler system fire watch policy is required to include all the items in Chapter 15.

NFPA 25, 2011 edition:
Minimum Requirements
15.1.1.1 This chapter shall provide the minimum requirements for a water-based fire protection system impairment program.
15.1.1.2 Measures shall be taken during the impairment to ensure that increased risks are minimized and the duration of the impairment is limited.
Impairment Coordinator
15.2.1 The property owner or designated representative shall assign an impairment coordinator to comply with the requirements of this chapter.
15.2.2 In the absence of a specific designee, the property owner or designated representative shall be considered the impairment coordinator.
Tag Impairment System
15.3.1 A tag shall be used to indicate that a system, or part thereof, has been removed from service.
15.3.2 The tag shall be posted at each fire department connection and the system control valve, and other locations required by the authority having jurisdiction, indicating which system, or part thereof, has been removed from service.
Impaired Equipment
15.4.1 The impaired equipment shall be considered to be the water-based fire protection system, or part thereof, that is removed from service.
15.4.2 The impaired equipment shall include, but shall not be limited to, the following: Sprinkler systems, Standpipe systems, Fire hose systems, Underground fire service mains, Fire pumps, Water storage tanks, Water spray fixed systems, Foam-water systems, Fire service control valves
Preplanned Impairment Programs
15.5.1 All preplanned impairments shall be authorized by the impairment coordinator.
15.5.2 Before authorization is given, the impairment coordinator shall be responsible for verifying that the following procedures have been implemented:

(1) The extent and expected duration of the impairment have been determined.
(2) The areas or buildings involved have been inspected and the increased risks determined.
(3) Recommendations have been submitted to management or the property owner or designated representative.
(4) Where a required fire protection system is out of service for more than 10 hours in a 24-hour period, the impairment coordinator shall arrange for one of the following:

(a) Evacuation of the building or portion of the building affected by the system out of service
(b) An approved fire watch
(c) Establishment of a temporary water supply
(d) Establishment and implementation of an approved program to eliminate potential ignition sources and limit the amount of fuel available to the fire

(5) The fire department has been notified.
(6) The insurance carrier, the alarm company, property owner or designated representative, and other authorities having jurisdiction have been notified.
(7) The supervisors in the areas to be affected have been notified.
(8) A tag impairment system has been implemented. (See Section 15.3.)
(9) All necessary tools and materials have been assembled on the impairment site.

Emergency Impairments
15.6.1 Emergency impairments shall include, but are not limited to, system leakage, interruption of water supply, frozen or ruptured piping, and equipment failure.
15.6.2 When emergency impairments occur, emergency action shall be taken to minimize potential injury and damage.
15.6.3 The coordinator shall implement the steps outlined in Section 15.5.
15.7 Restoring Systems to Service
When all impaired equipment is restored to normal working order, the impairment coordinator shall verify that the following procedures have been implemented:

(1) Any necessary inspections and tests have been conducted to verify that affected systems are operational. The appropriate chapter of this standard shall be consulted for guidance on the type of inspection and test required.
(2) Supervisors have been advised that protection is restored.
(3) The fire department has been advised that protection is restored.
(4) The property owner or designated representative, insurance carrier, alarm company, and other authorities having jurisdiction have been advised that protection is restored.
(5) The impairment tag has been removed.

The Resident Advocate Newsletter – May 2021

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The May 2021 Resident Advocate is now available.

The Resident Advocate provides:

  • Information on residents’ rights and care issues
  • News and updates on national policy
  • Self-advocacy tips for obtaining person-centered, quality care

This issue includes updates on the coronavirus disease (COVID-19) and suggestions for staying engaged and advocating for yourself to continue to receive the care you deserve. This issue also features an article on COVID-19 prevention tips and ideas to stay connected with friends and family during isolation.

This newsletter 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 with residents. Download this issue or past issues from this webpage.

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

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SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for October 1 – December 31 (Q4) of CY 2020 must be submitted no later than 11:59 p.m. on May 17, 2021.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to IRFs, LTCHs, and 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.

More information about SNF QRP can be found on the following webpages:

Payroll-Based Journal (PBJ) Submission Deadline Reminder

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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 1/1/21 through 3/31/21 is due on Saturday, May 15, 2021. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center (1-800-339-9313) no later than the Friday before the submission deadline as the Service Center will be unavailable to assist on the weekend.

More information about PBJ can be found on the following webpages:

Pioneer Network’s Virtual Symposium

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June 16, 2021: Envisioning the Future – Dementia Care: 2021 and Beyond

The second in our 2021 four symposium series based on the theme, Envisioning the Future, this virtual event is designed to provide valuable learning on the topic of Dementia Care. Held within a 6-hour window, there will be four general sessions followed by an opportunity to gather together with the general session speakers to ask questions, explore the topics, and further define our vision for the future.

Missouri Guidance for Long-Term Care Facilities

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DHSS has updated its guidance to reflect recent changes to CMS’ visitation guidance and to clarify and provide examples of those considered outside health care workers, which includes hospice workers (all disciplines). The changes include:

Visitor Vaccination Status
When both the resident and all of their visitors are fully vaccinated and while alone in a resident’s room or the designated visitation room, residents and their visitor(s) can choose to have close contact (including touch) and to not wear source control. Visitors should wear source control and physically distance from other healthcare personnel and other residents/visitors that are not part of their group at all other times while in the facility.

Visitors shall be given the opportunity to disclose their vaccination status to determine if the visitor may have close contact (including touch) and not wear source control while alone in a resident’s room or the designated visitation room, however the facility may not require visitors to disclose their vaccination status or to show proof of vaccination. Visitors that decline to disclose their vaccination status should adhere to the infection control principles of COVID-19 infection prevention for unvaccinated persons.

Outside Health Care Workers
Clarified and provided examples of outside health care workers and the expectation that outside healthcare workers must be permitted to come into the facility. Health care workers who are not employees of the facility, such as hospice workers (all disciplines), Emergency Medical Services (EMS) personnel, dialysis technicians, laboratory technologists, radiology technologists, social workers, clergy, etc., but provide direct care to the facility’s residents, must 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.

Communal Dining and Group Activities
Fully vaccinated residents can participate in communal dining and group activities without use of source control or physical distancing. If unvaccinated residents are present, all residents should use source control when not eating and unvaccinated residents should continue to remain at least 6 feet from others.

Pioneer Network: Hot Topics – Culture Change in Action

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May 6, 2021: Spring Forward: Three Person Centered Care Strategies to Change the Trajectory for Residents in Senior Living
Speakers: Rosemary Laird, M.D.,M.H.S.A; Deanna Vigliotta, National Sales Manager, TZMO USA, Inc; and Penny Cook, President & CEO, Pioneer Network

Join us for a discussion on some Hot Topics, including the importance of a person-centered approach to care; how now may be the perfect time for senior living communities to reevaluate their outdoor space for residents; how rethinking a community’s indoor space may help to increase social engagement for residents; and how revisiting current policies related to continence care may lead to better outcomes and costs savings. Three strategies will be explored in hopes that through education and understanding, together we can change lives.

Revised CMS Memos

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The Centers for Medicare and Medicaid Services release two revised QSO memos today. Below is a summary of the major revisions in each memo. Please read each in its entirety for all revisions. DHSS guidance will be updated to reflect the revisions in the CMS Visitation memo, however all facilities may begin using this revised guidance immediately.

CMS QSO-20-38-NH Revised – Updated Guidance Regarding Testing
The major revision to this document is regarding routine testing of staff. Routine testing of unvaccinated staff should be based on the extent of the virus in the community. Fully vaccinated staff do not have to be routinely tested. Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency.

CMS QSO-20-29-NH Visitation
The major revision to this document is regarding group activities and communal dining. The CDC has provided additional guidance on activities and dining based on resident vaccination status. For example, residents who are fully vaccinated may dine and participate in activities without face coverings or social distancing if all participating residents are fully vaccinated; if unvaccinated residents are present during communal dining or activities, then all residents should use face coverings when not eating and unvaccinated residents should physically distance from others. See the CDC guidance Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination for information on communal dining and activities.

Alert: Postcard Disguised as Official Office of Civil Rights (OCR) Communication

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OCR has been made aware of postcards being sent to health care organizations informing the recipients that they are required to participate in a “Required Security Risk Assessment” and they are directed to send their risk assessment to www.hsaudit.org. The link directs individuals to a non-governmental website marketing consulting services.

Please be advised that this postcard notification did not come from OCR or the U.S. Department of Health and Human Services. This communication is from a private entity – it is NOT an HHS/OCR communication. HIPAA covered entities and business associates should alert their workforce members to this misleading communication. Covered entities and business associates can verify that a communication is from OCR by looking for the OCR address or email address, which will end in @hhs.gov, on any communication that purports to be from OCR, and asking for a confirming email from the OCR investigator’s hhs.gov email address. The addresses for OCR’s HQ and Regional Offices are available on the OCR website at https://www.hhs.gov/ocr/about-us/contact-us/index.html, and all OCR email addresses will end in @hhs.gov. If organizations have additional questions or concerns, please send an email to: OCRMail@hhs.gov.

Suspected incidents of individuals posing as federal law enforcement should be reported to the Federal Bureau of Investigation.

Missouri Vaccinators to Resume Janssen/J&J Vaccine

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The CDC and FDA lifted the pause on the Janssen/J&J vaccine, and use of the vaccine will resume in Missouri. Please follow the links below to updated information for Missouri.

Useful Tools for Tracking Staff and Resident COVID-19 Vaccinations

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How Are You Tracking Staff and Resident COVID-19 Vaccinations?

As COVID-19 vaccination rates increase, there is an opportunity for your nursing home to ensure accurate vaccine tracking among team members and residents.

The Health Quality Innovation Network (HQIN) has developed COVID-19 vaccination administration and tracking tools to show you at-a-glance where your facility coverage stands and what gaps you need to address. Not only do these tools strengthen compliance monitoring, they also can complement the National Healthcare Safety Network (NHSN) COVID-19 vaccine reporting and help you target improvement efforts.

Click the links below to access the following tools:

SLCR Life Safety Code Information Series

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The Section for Long-Term Care Regulation will be releasing a series of Life Safety Code Information. You may also view the entire Life Safety Code document for reference.

Today’s subject is:

The facility must test receptacles (outlets) annually.

    1. What are the four test needed on non-hospital grade outlets?
    2. Are facilities required to document each electrical outlet annually?
    3. What documentation should the facility retain for each electrical receptacle?
    4. What happens if an outlet fails the inspection?
    5. What inspections does the facility need for hospital-grade outlets?

NFPA 99, 2012 edition:
6.3.3.2 Receptacle Testing in Patient Care Rooms.
6.3.3.2.1 The physical integrity of each receptacle shall be confirmed by visual inspection.
6.3.3.2.2 The continuity of the grounding circuit in each electrical receptacle shall be verified.
6.3.3.2.3 Correct polarity of the hot and neutral connections in each electrical receptacle shall be confirmed.
6.3.3.2.4 The retention force of the grounding blade of each electrical receptacle (except locking-type receptacles) shall be not less than 115 g (4 oz.).

The facility needs to document every outlet in the patient areas. The inspection report needs to show every outlet tested and includes areas such as resident rooms. The facility staff need to complete all four tests annually. These inspections may be a pass/fail for the four tests; however, the pass/fail must be for each specific test (e.g. grounding, polarity), and the pass/fail cannot just be for the outlet.

If the facility does not label every outlet, then there needs to be a system so everyone reading the documentation will know which outlet was tested. An example could be starting at the entrance, going around the room clockwise/counter clockwise, and naming the first outlet A, the second B and so on, until all outlets are recorded on the inspection sheet. The facility needs to document their system and use the same system throughout the facility. If one or more of the outlets in a room/area are hospital grade, the facility staff may document it on the form to show why annual testing did not occur (if applicable).

When an outlet fails any of the four tests, the facility needs to replace the outlet with a hospital grade outlet and staff need to document they replaced the outlet on the inspection sheet.

For any hospital grade outlet, the facility must create a system to complete a risk assessment and decide how often they want to complete the maintenance/testing, which can be longer than annually. The risk assessment system must be in place as soon as the facility has a hospital grade outlet. When due for an inspection and testing, these outlets must also be individually itemized on the documentation.

 

 

 

 

 

 

 

 

NFPA 99, 2012 edition:
10.3 Testing Requirements – Fixed and Portable.
10.3.1* Physical Integrity. The physical integrity of the power cord assembly composed of the power cord, attachment plug, and cord-strain relief shall be confirmed by visual inspection.
10.3.2* Resistance.
10.3.2.1 For appliances that are used in the patient care vicinity the resistance between the appliance chassis, or any exposed conductive surface of the appliance, and the ground pin of the attachment plug shall be less than 0.50 ohm under the following conditions:

(1) The cord shall be flexed at its connection to the attachment plug or connector.
(2) The cord shall be flexed at its connection to the strain relief on the chassis.

10.3.2.2 The requirement of 10.3.2.1 shall not apply to accessible metal parts that achieve separation from main parts by double insulation or metallic screening or that are unlikely to become energized (e.g., escutcheons or nameplates, small screws).
10.3.3* Leakage Current Tests.
10.3.3.1 General.
10.3.3.1.1 The requirements in 10.3.3.2 through 10.3.3.4 shall apply to all tests.
10.3.3.1.2 Tests shall be performed with the power switch ON and OFF.
10.3.3.2 Resistance Test. The resistance tests of 10.3.3.3 shall be conducted before undertaking any leakage current measurements.
10.3.3.3* Techniques of Measurement. The test shall not be made on the load side of an isolated power system or separable isolation transformer.
10.3.3.4* Leakage Current Limits. The leakage current limits in 10.3.4 and 10.3.5 shall be followed.
10.3.4 Leakage Current – Fixed Equipment.
10.3.4.1 Permanently wired appliances in the patient care vicinity shall be tested prior to installation while the equipment is temporarily insulated from ground.
10.3.4.2 The leakage current flowing through the ground conductor of the power supply connection to ground of permanently wired appliances installed in general or critical care areas shall not exceed 10.0 mA (ac or dc) with all grounds lifted.
10.5.2.1 Testing Intervals.
10.5.2.1.1 The facility shall establish policies and protocols for the type of test and intervals of testing for patient care–related electrical equipment.
10.5.2.1.2 All patient care–related electrical equipment used in patient care rooms shall be tested in accordance with 10.3.5.4 or 10.3.6 before being put into service for the first time and after any repair or modification that might have compromised electrical safety.
10.3.5.4 Touch Leakage Test Procedure. Measurements shall be made using the circuit, as illustrated in Figure 10.3.5.4, with the appliance ground broken in two modes of appliance operation as follows:

(1) Power plug connected normally with the appliance on
(2) Power plug connected normally with the appliance off (if equipped with an on/off switch)

Conversations with Carmen

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May 21, 2021: Artifacts of Culture Change (ACC) 2.0 and ACC – Assisted Living: Part 3
Presenters: Host Carmen Bowman and her Guest Karen Schoeneman

An Artifacts 2.0 version for nursing homes, and a first-ever Artifacts for Assisted Living are now available, thanks to the Pioneer Network. The ACC is an internal self-assessment tool — inspirational and educational, reflecting concrete practices that change institutional culture or “artifacts” of culture change. Walk through each of the over-130 items with the developers Karen Schoeneman and Carmen Bowman in three sessions (March 19, April 23 and May 21) and be inspired to learn culture change practices you may have not considered – to shift the focus from institutional to individual, and institution to home.

These detailed and in-depth sessions build on the overview provided during the Pioneer Network’s webinar (Feb. 18, 2021) introducing the Artifacts.

SPECIAL COVID PRICING STILL IN EFFECT!

Preceptor Training

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June 6, 2021: Camden on the Lake, Lake Ozark
October 21, 2021: MANHA Office, Jefferson City

The Missouri Board of Nursing Home Administrators requires an individual applying to become a preceptor to future nursing home administrators who require an AIT program in Missouri to complete a prescribed course of instruction and training. A work internship in a nursing home under the direct supervision of a licensed nursing home administrator who is designated as a preceptor by the board is an important part of the preparatory training. The supervision by a preceptor is a valuable contribution to the growth and development of the intern, to nursing home administration, and ultimately, long term care. This course has been approved by the Missouri Board of Nursing Home Administrators as a requirement in the application process of becoming a preceptor.

Please see the brochure for registration details.

Standing Orders for Naloxone and COVID-19 Vaccination and Testing

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With the appointment of Acting Director of Health and Senior Services Robert J. Knodell, the Department has issued identical orders and standing orders as to what was in place prior to this transition. The only differences are the date and signatories. As Acting Director Knodell is not a physician, those medical standing orders that may only be authorized by a physician have been re-issued under the authority of the DHSS State Epidemiologist, Dr. George Turabelidze who has held an unrestricted physician license in Missouri since 1996. These updated orders cover COVID-19 vaccination and testing needs as well as Naloxone administration and are intended to mitigate any challenges associated with transition.

For purposes of administration needs, the following information is provided for the purpose of execution of the established orders in an appropriate authorized manner:

Dr. George Turabelidze
NPI Number: 1750496246

The revised orders may be found at the following links:
https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/statewide-orders.php
https://health.mo.gov/data/opioids/pdf/naloxone-standing-order.pdf

SLCR Life Safety Code Information Series

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The Section for Long-Term Care Regulation will be releasing a series of Life Safety Code Information. You may also view the entire Life Safety Code document for reference.

Today’s subject is:

Can residents have a microwave in their room?

K324 – Cooking is not allowed in resident rooms. NFPA 19.3.2.5.3 and 19.3.2.5.4
K925 – Cooking appliances cannot be within 15 feet of an area of administration in a resident room.

NFPA 101, 2012 edition:
18/19.3.2.5.2* Where residential cooking equipment is used for food warming or limited cooking, the equipment shall not be required to be protected in accordance with 9.2.3, and the presence of the equipment shall not require the area to be protected as a hazardous area.
18/19.3.2.5.4* Within a smoke compartment, residential or commercial cooking equipment that is used to prepare meals for 30 or fewer persons shall be permitted, provided that the cooking facility complies with all of the following conditions:

(1) The space containing the cooking equipment is not a sleeping room.
(2) The space containing the cooking equipment shall be separated from the corridor by partitions complying with 19.3.6.2 through 19.3.6.5.
(3) The requirements of 19.3.2.5.3(1) through (10) and (13) are met.

Pioneer Network’s Hot Topics

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April 22, 2021: Compassionate Leadership in Action

A characteristic we look for in leaders is compassion, but what does it look like in practice? How do leaders support a culture of compassion in their organization? What characteristics do they share?

Our panelists are leaders at organizations known for their compassionate cultures. Donna Moore, serves as COO at Isakson Living, Deke Cateau, is the CEO, at A.G. Rhodes, and Jill Vitale-Aussem, who through most of the pandemic served as CEO of The Eden Alternative and is now CEO of Christian Living Communities. Each will share the beliefs and values that guide their leadership philosophies and discuss how they have put them into action to grow and support a culture of compassion in their organizations. They will also provide tangible ideas you can take away as you work to support and grow a culture of compassion in your organization.

As a Thank-You to our Coalition Partners, use code PNCoalition2021 for a 15% Discount

COVID-19 FREE Testing

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The Missouri Department of Health and Senior Services continues to offer FREE COVID-19 testing. Individuals seeking a free testing opportunity are not required to pre-register or have an appointment, simply show up to one of the events below to receive the test. A government issued ID is not a requirement for this testing, but having one available onsite speeds up the registration process. Testing is still a very important tool in fighting the COVID-19 pandemic.

Event information can always be found at www.health.mo.gov/communitytest. Additional sites (with regular or one-time opportunities) may be added as indicators suggest the need for additional testing.

CMS Memo: QSO-21-15-ALL: Updated Guidance for Emergency Preparedness-Appendix Z of the State Operations Manual (SOM)

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CMS has provided updated guidance for the emergency preparation regulations (Appendix Z). This update is effective immediately.

  • Burden Reduction Final Rule Interpretive Guidelines: The Centers for Medicare &Medicaid Services (CMS) is releasing interpretive guidelines and updates to Appendix Z of the State Operations Manual (SOM) as a result of the revisions of the Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (CoPs) (CMS 3346-F) Final Rule.
  • Expanded Guidance related to Emerging Infectious Diseases (EIDs): CMS is also providing additional guidance based on best practices, lessons learned and general recommendations for planning and preparedness for EID outbreaks.

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updated-guidance-emergency-preparedness-appendix-z-state-operations-manual-som.

Updated Guidelines for the Anti-SARS-CoV-2 Monoclonal Antibody Treatment of COVID-19

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Health Advisory 4-13-22

SARS-CoV-2, virus causing coronavirus disease 2019 (COVID 19), has been evolving over time, resulting in genetic variation in the population of circulating viruses across the world, including the United States. Some of those variations in viral genome can cause resistance to one or more of the monoclonal antibodies (mAb) therapies authorized to treat COVID-19. The ongoing surveillance of human and sewage samples by the Missouri Department of Health and Senior Services (DHSS) indicates rise in variant SARS-CoV-2 in Missouri, similar to other states. This DHSS Health Advisory urges health care providers in Missouri to follow newly updated COVID-19 mAB treatment guidelines issued by the National Institute of Health (NIH).

Please view the full Health Advisory for all details – Updated Guidelines for the Anti-SARS-CoV-2 Monoclonal Antibody Treatment of COVID-19 (4.13.21).

Missouri Pauses J&J COVID-19 Vaccine Administration

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Johnson & Johnson’s Janssen COVID-19 vaccine administration is being paused in Missouri until further notice.

“In an abundance of caution and as per federal guidelines, we are pausing vaccination with Johnson & Johnson’s Janssen vaccine until further notice in Missouri,” said Dr. Randall Williams, director of the Department of Health and Senior Services (DHSS). “We anticipate having more information shortly to make further decisions about overall vaccine distribution in light of this new development and will continue to update citizens who have been vaccinated with the J&J vaccine after the advisory committee meets at the federal level tomorrow.”

A new standing order for this vaccine has been issued by DHSS and is effective immediately.

People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider. Patients with other clinical questions should contact their health care provider or call the COVID-19 hotline at 877-435-8411.

Providers are asked to keep any on-hand J&J vaccine in the appropriate storage unit and label it “quarantine-do not use” until further notice.

As the State of Missouri receives more information, it will be made available.

Long-Term Care Facility Regulatory Waiver Updates

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On 5/1/2021, the following long-term care facility waivers will either end or implementation guidance has been revised. See the implementation guidance(s) below for full details.

Effective 05/01/2021, the following regulatory waivers will end for all facilities (including Medicare/Medicaid certified):

Residential Care Facilities and Assisted Living Facilities
19 CSR 30-86.022(3) fire extinguisher inspections/maintenance
19 CSR 30-86.022(4)(A) and (C) range hood extinguishing system testing
19 CSR 30-86.022(9)(C) and (D) fire alarm system inspections/certification
19 CSR 30-86.022(11)(D),(E) and (F) and §198.074.2-4 RSMo., sprinkler system inspections/certification
19 CSR 30-86.032(13) electrical inspections
19 CSR 30-86.042(37) residential care facility documentation of the resident’s current medical status and any special orders or procedures
19 CSR 30-86.047(26) assisted living facility documentation of a physical examination prior to admission

Skilled Nursing Facility and Intermediate Care Facility (certified and state licensed only)
19 CSR 30-85.022(8) fire extinguisher inspections/maintenance
19 CSR 30-85.022(9) range hood extinguishing system testing
19 CSR 30-85.022(10)(C) fire alarm system inspections/certification
19 CSR 30-85.022(11)(A) sprinkler system inspections/certification
19 CSR 30-85.032(31)(B) electrical inspections
19 CSR 30-85.042(7) written agreements with outside resources used to provide services to the residents.
19 CSR 30-85.042(21) comprehensive orientation program within sixty (60) days of employment with nursing assistants who have not successfully completed the state-approved training program.

Adult Day Care Programs
19 CSR 30-90.050(8)(D)3.C- orders concerning treatments and medications
19 CSR 30-90.070(2)(A) annual written approval from the appropriate local fire safety officials, certifying that the facility complies with local fire codes
19 CSR 30-90.070(2)(C) fire extinguisher inspections/maintenance

Effective 05/01/2021, the following regulatory waiver implementation guidance has been amended for all facilities (including Medicare/Medicaid certified):

RCF-ALF-ICF-SNF and ADC
Tuberculosis testing: 19 CSR 30-85.042 (27), 19 CSR 30-86.042 (17) and (18), 19 CSR 30-86.047(18) and (19), and 19 CSR 30-90.040(7)

SNF
Regular visiting hours: 19 CSR 30-85.042 (11)

 

19 CSR 30-86.022 and 86.032 Waivers revised eff 5-1-2021
19 CSR 30-86.042 RCF waivers effective 5-1-21
19 CSR 30-86.047 ALF waivers effective 5-1-2021
19 CSR 30-85 SNF-ICF Waiver eff 5-1-2021
19 CSR 30-85.042-27 SNF-TB testing revised eff 5-1-2021
19 CSR 30-90 ADC waivers effective 5-1-2021

Summary of CDC Guidance on Quarantine

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On March 29, 2021, the CDC issued updated guidance regarding quarantining nursing home residents. Whether a resident should be quarantined depends on factors such as vaccination status, exposure to someone with COVID-19, and length of time outside of the facility. This summary provides basic information about quarantine and indicates when quarantine is necessary. https://theconsumervoice.org/uploads/files/issues/Quarantine_summary_4-5-21_v2.pdf.

PASRR and Person-Centered Behavioral Health Services

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Notifying the Department of Mental Health, promptly after a significant change in the mental or physical condition of a resident who has mental illness or intellectual disability for resident review, is key to ensuring individuals with a mental disorder or intellectual disabilities receive the care and services they need in the most appropriate setting, when a significant change in their status occurs. A significant change for purposes of PASRR may or may not trigger a significant change in status assessment in the RAI/MDS process.

For behavioral health services, a “significant change” is a major decline or improvement in a resident’s status that

  • will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions; the decline is not considered “self-limiting” (NOTE: Self-limiting is when the condition will normally resolve itself without further intervention or by staff implementing standard clinical interventions to resolve the condition.);
  • impacts more than one area of the resident’s health status; and
  • requires interdisciplinary review and/or revision of the care plan.

Examples of such changes include, but are not limited to:

  • A resident who demonstrates increased behavioral, psychiatric, or mood-related symptoms.
  • A resident with behavioral, psychiatric, or mood-related symptoms that have not responded to ongoing treatment.
  • A resident who experiences an improved medical condition—such that the residents’ plan of care or placement recommendations may require modifications.
  • A resident whose significant change is physical, but has behavioral, psychiatric, or mood-related symptoms, or cognitive abilities, that may influence adjustment to an altered pattern of daily living.
  • A resident whose condition or treatment is or will be significantly different than described in the resident’s most recent PASARR Level II evaluation and determination.
  • A resident who indicates a preference to leave the facility. (This preference may be communicated verbally or through other forms of communication, including behavior.)

Referral to DMH should be made as soon as the criteria indicative of a significant change are evident – the facility should not wait until the significant change in status assessment is complete. To notify DMH of a change in status related to disability or mental illness, providers can access the Notification to DMH for CIS and Resident Review Referral Form on DMH’s webpage: https://dmh.mo.gov/dev-disabilities/programs/pasrr-level-ii-assessments.

  • Provide ID/MI diagnosis. Describe change in condition or status and the it meets the criteria for reporting the change to DMH.
  • Did the facility access the Behavioral Health Crisis Line for assistance with unsafe behaviors?
  • Date of most current PASRR evaluation and description of how the previous PASRR evaluation differs from the individual’s current condition.

The referral form and questions related to the resident review process should be emailed to: DMHNotifications@dmh.mo.gov.

Are you survey ready? Review CMS’ Behavioral and Emotional Status Critical Element Pathway at http://cmscompliancegroup.com/wp-content/uploads/2017/08/CMS-20067-Behavioral-Emotional.pdf.