The Department of Health and Senior Services Central Office Medical Review Unit (COMRU) and the Department of Mental Health (DMH) are pleased to announce changes to the processing of Pre-Admission Screening and Resident Review (PASRR) Level 1 applications that indicate a Level 2 evaluation should be completed – those with serious mental illness and/or intellectual disability/developmental disability related diagnoses. The goal of these changes is to streamline the process and to decrease the review time for these applications.

Currently, Level 1 applications that indicate a Level 2 evaluation are first reviewed by COMRU staff to determine whether the applicant meets Nursing Facility Level of Care (LOC) before the application is sent to the DMH for a Level 2 evaluation by DMH’s contractor, Bock Associates. This review process can take several working days to complete, which may delay the transition to a nursing home.

Effective July 1, 2025, Level 1 applications that indicate a Level 2 evaluation, based on the responses on the application, will be sent to DMH for review and determination of whether a Level 2 evaluation is necessary. The LOC determination will be made after DMH makes the determination on the Level 2 evaluation. DHSS expects to complete the LOC within one business day of the DMH determination.

 This change will have no impact to individuals completing applications – there will be no changes to the application or to the submission process.

COMRU does receive several applications that do not indicate a Level 2 evaluation based on the responses on the application, however a review of the application and attachments/supporting documentation shows the application should have indicated a Level 2 evaluation. Often, the individual has already been admitted to a nursing home and payment to the nursing home may be delayed until the Level 2 evaluation is complete. A good refresher on the conditions that indicate a Level 2 evaluation can be found here. Please ensure a thorough review of the application and supporting documentation when making admission decisions. An additional tool that will aid in decision-making is a review of the information in CyberAccess. CyberAccess offers many services to providers, such as where Medicaid clients have been receiving services, billed diagnosis and much more. To register for CyberAccess, please contact 888-581-9797.

A new online application link will be provided on COMRU webpage (https://health.mo.gov/seniors/nursinghomes/pasrr.php) starting July 1, 2025.

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 12, Issue 3).

In this issue:

• Honoring the Journey: Upholding Compassion and Quality Through F684 and F849
• Disasters Don’t Wait for Day Shift
• ICAR Corner: TB or Not TB… That is the Question
• New Resident Admissions
• Hip, Hip, Hooray! Moving Forward!

Any registered supplemental health care services agency that contracts with a health care facility participating in Medicare or Medicaid is required to submit quarterly reports to the department that contain the following information:

• A detailed list of each health care facility participating in Medicare or Medicaid with whom the agency has contracted over the prior quarter;
• A detailed list of the average “hourly” amount charged by the agency to the health care facility over the prior quarter, broken down by health care facility and each individual health care personnel category within each job classification (including but not limited to nursing, therapy, dietary/nutrition, lab, and radiology); and
• A detailed list of the average “hourly” amount paid by the agency to health care personnel over the prior quarter, broken down by health care facility and each individual health care personnel category within each job classification, including but not limited to nursing, therapy, dietary/nutrition, lab, and radiology.

Pursuant to section 198.644, RSMo, the department is required to prepare an annual report of aggregate data received from the agencies without including information specific to any one agency. This report summarizes data received by the department in 2024, which was the first full year the department received reports.

The 2024 report can be found here: https://health.mo.gov/safety/shcsa/annual-report.html.

Creative writing and artistic expression are meaningful and compelling ways to highlight the importance of residents’ rights and how these rights can be carried out in all long-term care settings. The Resident’s Voice Challenge encourages residents to submit essays, poems, artwork, drawings, or videos related to the theme.

In celebration of Consumer Voice’s 50th Anniversary, we are creating a coffee table book featuring residents’ voices. We’re seeking creative artwork (posters, paintings, drawings) or written entries (essays, poems) of 50 words or less. Individuals whose entries are selected for inclusion in the book will receive a complimentary copy of the book.

Use these questions to inspire you:

• What makes you feel empowered?
• Why is it important to stand up for your rights? For quality care?
• What contributes to your quality of life?
• What is needed for quality care to be provided in a long-term care facility?
• How can others (family, community members, etc.) support bringing about quality care and quality of life in long-term care facilities?

How to Submit

1. Read the full Resident’s Voice Challenge Criteria before submitting.
2. Email submissions to info@theconsumervoice.org by June 30, 2025.
   • Include a mailing address with your submission for residents to receive certificates of participation.

Submissions featuring photo or videos must include completed release forms for each resident.