Due to the COVID-19 situation, the Board recognizes the need for Missouri administrators to have flexibility in completing the required continuing education (CE) clock hours for the 2020 license renewal and the memo provides the important updated information.
Category: Long Term Care Blog
Medicare FFS waiver response to COVID-19
Please see the documents below for information.
SLCR Guidance on Residents Leaving the Facility – Updated March 17, 2020 (Additions in red text)
This is guidance from SLCR; it is not a mandate but rather provides facilities with an avenue to protect the health and safety of residents.
It is appropriate for facilities to ask residents not to leave the facility, unless for a necessary medical reason that cannot be addressed in the facility. For those insistent on taking residents out of the facility, SLCR recommends the following:
- Only legally authorized persons may remove a resident from the facility. This may be a durable power of attorney for healthcare (if the DPOA has been enacted), a legal guardian or the resident themselves.
- Before a resident leaves, the facility should follow the discharge regulations to the extent possible so that the resident receives appropriate care while away from the facility.
- Upon leaving the facility, the resident, their legal representative and all those required by regulation should be given a written emergency discharge notice. It is imperative that the notice contain the required elements stated in regulation, including the reason for discharge (as permitted in regulation) and the location to which the resident is being discharged.
- Those taking the resident out of the facility are to be informed that the resident will not be permitted to return until the restrictions currently in place are lifted. When appropriate, residents may be required to obtain clearance from their medical provider which may include proof of a negative COVID-19 screening.
For residents, primarily in RCFs and ALFs, who leave the facility on a frequent basis, the facility will need to determine at what point those outings pose a risk to the health and safety of the residents in the facility. This includes, but is not limited to, the location the resident is going, whether there are positive COVID-19 cases in the community, whether there is community transmission of the virus, etc. This guidance does not require facilities to issue an emergency discharge notice every time a resident leaves a facility. The resident and their legal guardian, when applicable, should discourage outings, attempt to meet the needs of residents without them leaving the facility, clearly communicate the expectations to residents (including any screening required upon return) and work together should the need arise to give an emergency discharge notice.
PPE resource request for accessing state cache assets posted: Accepting requests Monday, March 16, 2020
The resource requesting process for PPE in our state cache was posted to the DHSS website this at this link:
https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php.
All resource requests must go through the respective healthcare coalition (maps and contact information are on the website). The healthcare coalition then submits to the Missouri Department of Health and Senior Services for review, approval and processing. All shipments will occur from Jefferson City and be sent via either Federal Express (FedEx) or United Parcel Service (UPS).
Visitation Guidance for Facilities
Please see Department of Health and Senior Services guidance regarding visitation restrictions in all long term care facilities including residential care facilities, assisted living facilities, intermediate care facilities, skilled nursing facilities, and intermediate care facilities for persons with intellectual disabilities.
This guidance along with similar guidance from the Centers for Medicare and Medicaid Services should be implemented immediately.
These documents will also be posted to the Department’s COVID-19 website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ under the Health Care Professionals tab.
COVID-19 Information and Resources
All COVID-19 information and resources on the DHSS website for long-term care facilities should be used by all levels of care, including Skilled Nursing, Intermediate Care, Assisted Living, and Residential Care Facilities. Adult Day Care programs will also benefit from reading the information and applying proper infection control practices.
DHSS Health Alert: UPDATED Missouri COVID-19 PUI Definition and Testing Algorithm
Please see the Health Alert from DHSS for more information.
LTCF Webinar: Coronavirus Disease 2019
This video includes information from the Department of Health and Senior Services regarding guidance and education surrounding COVID-19. The focus is on the basics of COVID-19 (symptoms, who is at most risk), the types of coronavirus, how long term care communities can prepare and testing protocols.
The LTCF Video is available at https://youtu.be/u-OZNQ3A-fs.
Please note information is changing rapidly so please check the Department’s COVID-19 website frequently for updated information.
Supporting Coronavirus Prevention in LTC Facilities
Some LTC homes will make the difficult decision to limit and/or restrict entry of family and friends into their care settings. To help family and friends understand restrictions being put into place by many LTC providers, Consumer Voice, a national Ombudsman program resource, has put together a webpage: https://theconsumervoice.org/issues/other-issues-and-resources/covid-19.
News Release: Missouri opens novel coronavirus information hotline
JEFFERSON CITY, MO –The Missouri Department of Health and Senior Services (DHSS) activated a statewide public hotline for citizens or providers needing guidance regarding the novel coronavirus, or COVID-19. At 8 a.m. today, the hotline opened and can be reached at 877-435-8411. The hotline is being operated by medical professionals and is available 24 hours a day, 7 days a week.
“Communication is vital to our response to this rapidly-evolving situation,” said Dr. Randall Williams, director of DHSS. “For several weeks, our COVID-19 webpage has been and continues to be a great resource for the public, but having the hotline as an additional resource will likely be invaluable as citizens seek guidance for their concerns.”
To date, 46 patients in Missouri have been tested for the virus that causes COVID-19; one of those has tested positive.
“It is important to know what to do if you have concerns about an illness during this outbreak,” said Williams. “For those who may be at risk for COVID-19, we encourage them to utilize this hotline or call their health care provider or local public health agency to inform them of their travel history and symptoms. They’ll be instructed on how to receive care without exposing others to the possible illness.”
Simple preventive actions that help prevent the spread of all types of respiratory viruses include:
- Avoid close contact with people who are sick.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
For more information, visit www.health.mo.gov/coronavirus or the CDC’s COVID-19 website.
# # #
Past Missouri COVID-19 news releases:
- Governor Parson, State, and Local Officials Confirm First Case of COVID-19 to Test “Presumptive Positive” in Missouri (March 7, 2020)
- CDC releases revised COVID-19 guidance for health care professionals (Feb. 28, 2020)
- DHSS Director Williams meets at White House to discuss federal, state and local health officials’ strategic alignment on COVID-19 (Feb. 27, 2020)
- Missouri DHSS and partners continue planning and preparing for novel coronavirus (Feb. 10, 2020)
- Update and Interim Guidance on Outbreak of COVID-19 (2019-nCoV) (Feb. 1, 2020)
- DHSS provides update on novel coronavirus (nCoV) (Jan. 27, 2020)
- Missouri DHSS monitors novel coronavirus (Jan. 22, 2020)
About the Missouri Department of Health and Senior Services: The department seeks to be the leader in protecting health and keeping people safe. More information about DHSS can be found at http://health.mo.gov or find us on Facebook and Twitter @HealthyLivingMo
CMS Memo: QSO-20-17-ALL: Guidance for use of Certain Industrial Respirators by Health Care Personnel
Guidance for use of Certain Industrial Respirators by Health Care Personnel
- The Centers for Medicare & Medicaid Services (CMS) CMS is committed to taking critical steps to ensure America’s health care facilities are prepared to respond to the threat of the Coronavirus Disease 2019 (COVID-19) and other respiratory illnesses.
- The memo clarifies the application of CMS policies in light of recent Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) guidance expanding the types of facemasks healthcare workers may use in situations involving COVID-19 and other respiratory infections.
Please see the memo for further details.
For additional information, please visit the Department’s website at health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/. This site also contains a link specific to long-term care communities.
CMS Memo: QSO-20-14-NHL: Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (REVISED)
Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (REVISED)
- CMS is committed to taking critical steps to ensure America’s health care facilities and clinical laboratories are prepared to respond to the threat of the COVID-19.
- Guidance for Infection Control and Prevention of COVID-19 – CMS is providing additional guidance to nursing homes to help them improve their infection control and prevention practices to prevent the transmission of COVID-19, including revised guidance for visitation.
- Coordination with the Centers for Disease Control (CDC) and local public health departments – We encourage all nursing homes to monitor the CDC website for information and resources and contact their local health department when needed (CDC Resources for Health Care Facilities: https://www.cdc.gov/coronavirus/2019- ncov/healthcare-facilities/index.html) .
- Following the Food and Drug Administration’s (FDA) emergency use authorization (EUA) expanding the use of certain industrial respirators to health care personnel, CMS is clarifying that such use is appropriate in Medicare/Medicaid certified providers and suppliers.
Please see the memo for further details.
For additional information, please visit the Department’s website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/.
DHSS Long-Term Care COVID-19 Webinar
DHSS Long Term Care COVID-19 Webinar
Monday, March 9, 2020 10:00 am
Representatives from the Department of Health and Senior Services will be hosting a webinar to provide information, guidance and education surrounding COVID-19. The webinar will focus on the basics of COVID-19 (symptoms, who is at most risk), the types of coronavirus, how long term care communities can prepare, testing protocols and coordination with healthcare coalitions.
Please join us for this important webinar.
Webex Event Registration
https://stateofmo.webex.com/stateofmo/onstage/g.php?MTID=eacb119d9cc214df93ea6e8e3e4c294fb.
After registration, you will receive a confirmation email with further instructions including the webinar link.
If you prefer to join via audio conference:
Call-in toll number (US/Canada): 1-650-479-3207
Event number (access code): 801 063 245
For additional information, please visit the Department’s website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/. This site also contains a link specific to long-term care communities.
Missouri LGBT Older Adult Alliance
March 9, 2020: Missouri LGBT Older Adult Alliance
The Missouri Division of Senior and Disability Services, along with several Area Agencies on Aging and National SAGE and local SAGE chapters, invite you to join us for an informational session highlighting the newly formed MO LGBT Aging Alliance. The Alliance is intended to be a collaborative effort that will inform communities and service providers of inclusive practices that will ensure LGBT older Missourians feel welcome and supported across the state. The Alliance will work with engaged stakeholders and allies to develop a profile to practice module for inclusion in the Missouri State Plan on Aging, based upon the groundbreaking work of the National Resource Center on LGBT Aging.
Please see the Missouri LGBT Older Adult Alliance Flier for more information.
SNF PDPM Claims Issue
CMS recently posted the following on their MLN Connects webpage, which can be found at www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-02-27#_Toc33530674.
Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October. In the interim:
- Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims;
- To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then rebill in sequential order; or, hold adjustments (when allowable) until October when they will process correctly;
- We encourage you to submit a complete bill at the time of entry.
CMS Memo: QSO-20-11-NH
Release of Additional Toolkits to Ensure Safety and Quality in Nursing Homes
The Centers for Medicare & Medicaid Services (CMS) is announcing the release of two toolkits that align with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes.
- Developing a Restful Environment Action Manual (DREAM) Toolkit – CMS has created a toolkit that offers education and person-centered, practical interventions that nursing home administrators, directors of nursing, and bedside staff can implement to promote high-quality sleep for residents living with dementia.
- Head-to-Toe Infection Prevention (H2T) Toolkit – CMS has created a toolkit that offers educational materials and practical interventions for bedside staff designed to prevent common infections by improving activities of daily living (ADL) care.
Please see the full memo download at www.cms.gov/httpswwwcmsgovmedicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/release-additional-toolkits-ensure-safety-and-quality-nursing-homes.
CMS Memo: QSO-20-09-ALL
Information for Healthcare Facilities Concerning 2019 Novel Coronavirus Illness (2019-nCoV)
- Information Regarding Patients with Possible Coronavirus Illness: the U.S. Centers for Disease Control and Prevention (CDC) has issued information on the respiratory illness caused by the 2019 Novel Coronavirus (2019-nCoV). Links to these documents are provided.
- Healthcare Facility Expectations: CMS strongly urges the review of CDC’s guidance and encourages facilities to review their own infection prevention and control policies and practices to prevent the spread of infection.
Please see the full memo download at www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/information-healthcare-facilities-concerning-2019-novel-coronavirus-illness-2019-ncov.
Questions about this memorandum should be addressed to QSOG_EmergencyPrep@cms.hhs.gov.
Questions about the 2019-nCoV guidance/screening criteria should be addressed to the State Epidemiologist or other responsible state or local public health officials in your state.
MC5 2020 Spring Roadshow
April 23, 2020: Understanding Young Coworkers: Recruiting Successful Relationships
Location: St. Joe Medical Center, Health and Education Auditorium, Kansas City
April 24, 2020: Understanding Young Coworkers: Recruiting Successful Relationships
Location: St. Charles Community College, Daniel Conoyer Social Sciences Bldg., Cottelville
Presented by Clint Maun, CSP
Aging Services organizations of today and the future must learn how to successfully utilize younger coworkers in management positions. As this important resource is hired and retained, healthcare professionals must implement success strategies to produce collaborative efforts which ultimately benefit our customers. This session provides essential, up-to-date information on how to attract young talent, develop flexible practices that assist with retention and assimilating the young/new coworkers with mature staff.
- Identify the current hot buttons for retention in today‘s healthcare environment.
- Implement the successful involvement of younger coworkers on teams, committees and projects.
- Discover methods for effective updates on work performance.
- Become proficient in how to lead – not just manage.
- Utilize younger coworkers as managers.
- Develop targeted messages that potential applicants find attractive and respond to.
- Prepare the targeted pay/benefit strategy for successful recruitment.
- Implement a team-based effort for recruitment by current employees.
This session delivers timely and proven strategies developed from current staff development consulting initiatives nationwide; includes case studies, examples, lecture, humor, question/answer and group discussion.
More details available on the MC5 Roadshow Conference page.
Pioneer Network & Eden Alternative Webinar
March 19, 2020: Death as a Collaborative Event: Empowering Lessons from End-of-Life Doulas
Faculty: Jane Whitlock, BA, End-of-life Doula, and Sandra L. Place, LNHA, MA, Healthcare Educator and Consultant and End-of-Life Doula
The Pioneer Network and Eden Alternative have joined to bring you this 90-minute webinar. Timely topics presented by thought leaders in the field of aging.
Transforming the culture of care and support doesn’t stop with how we live – it’s also about how we die. As change agents, we have much to learn about the art of supporting a meaningful death experience from end-of-life doulas. Once reserved to describe individuals who assist birthing mothers, the word “doula” now also applies to those who support the emotional, physical, and spiritual well-being of the dying. Join in conversation with two passionate end-of-life doulas and explore how their unique wisdom and practices strengthen the goals of person-directed care. Participants will have the opportunity to submit questions in advance.
Federal Review Course for Nursing Home Administrators Exam
April 8-9, 2020: St. Charles
July 13-14, 2020: Springfield
November 16-17, 2020: Kansas City
The purpose of the Review Course is to help attendees prepare for the nursing home administrator federal licensure exam. Review Course materials have been revised and updated to reflect the structure of the current examination.
Alzheimer’s Disease/Dementia Care Seminar
April 14, 2020: Jefferson City
October 20, 2020: Jefferson City
This is the required seminar for those pursuing certification and who qualify as CDP/Certified Dementia Practitioner or for those who just want to enhance their dementia education. To see if you qualify for CDP: www.NCCDP.org.
MoHIMA & KHIMA Joint Meeting
April 22, 2020: LTC Preconference Session
Location: DoubleTree by Hilton, Overland Park, KS
The Missouri Health Information Management Association (MoHIMA) in collaboration with the Kansas Health Information Management Association (KHIMA) is hosting a LTC pre-conference for their annual meeting. There will be sessions to address Privacy and Security in LTC, PDPM ICD-10 coding, as well as regulatory updates from Missouri and Kansas.
Social Service Designee Workshop
April 27-30, 2020: Jefferson City
This course will discuss the philosophy of long-term care, the settings in which a Social Service Designee works and the demographics of the people they serve. Students will learn the aging process, the performance skills of the Social Service Designee and understand the role and function of this position.
Clinical Supervisor Workshop
June 16, 2020: Jefferson City
This state-required and MO Dept of Health & Senior Services-approved workshop is designed to prepare registered and licensed nurses to supervise nurse assistant students during their required on-the-job experience.
CMT Instructor Workshop
June 18, 2020: Jefferson City
This workshop is designed to prepare RNs to instruct Medication Technician students for long-term care facilities in MO. Upon completion, attendees will be able to identify specific requirements and regulations for the Medication Technician training, utilize appropriate testing methods, determine appropriate curriculum, list requirements of examination and registration process.